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. 2015 Jan;147(1):216-223.
doi: 10.1378/chest.14-1180.

Validation of a scoring system to predict recurrence of resected solitary fibrous tumors of the pleura

Luis F Tapias  1 , Olaf Mercier  2 , Maria R Ghigna  2 , Benoit Lahon  2 , Hang Lee  1 , Douglas J Mathisen  1 , Philippe Dartevelle  2 , Michael Lanuti  1
Affiliations

Validation of a scoring system to predict recurrence of resected solitary fibrous tumors of the pleura

Luis F Tapias et al. Chest. 2015 Jan.

Abstract

Background: Solitary fibrous tumors of the pleura (SFTPs) are infrequent neoplasms with no standardized criteria to predict risk of recurrence after curative surgery. The aim of the present study is to validate a recently proposed recurrence score in a large European cohort of patients with SFTP.

Methods: Validation of a previously published scoring system was assessed in a population of 113 patients who underwent complete resection of SFTPs. Patients were scored according to the pleural origin, morphology, size, hypercellularity, presence of necrosis or hemorrhage, and number of mitoses in their SFTPs. Receiver operating characteristic curves were plotted for the score. Time to recurrence analysis was performed using the Kaplan-Meier and Cox proportional hazards methods.

Results: After a mean follow-up of 13.2 ± 7.3 years, there were nine recurrences (8.0%). Score performance to predict recurrence was as follows: sensitivity = 78%, specificity = 74%, positive likelihood ratio = 3.0, and negative likelihood ratio = 0.3. A cutoff of 3 points was used to classify 79 patients (69.9%) at low risk and 34 patients (30.1%) at high risk for recurrence. A high-risk classification was significantly associated with more recurrences during follow-up (P = .004), worse overall survival (P = .0008), more extensive lung resections (P = .001), and the use of adjuvant therapies (P = .009). The present score outperformed England's criteria (P = .049) and de Perrot classification (P < .001) when predicting SFTP recurrence.

Conclusions: The proposed scoring system, which combines common clinical and histologic features of resected SFTPs, remains predictive of recurrence in a separate patient population. The simple score may guide the postoperative surveillance of this uncommon tumor.

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Figures

Figure 1 –
Figure 1 –
ROC curve for the recurrence score. ROC = receiver operating characteristic.
Figure 2 –
Figure 2 –
A, B, Kaplan-Meier recurrence curves for the entire cohort (A) and according to risk stratification based on the scoring system (B). C, D, Overall survival curves for the entire cohort (C) and according to risk stratification based on the scoring system (D).
Figure 3 –
Figure 3 –
Comparison of ROC curves for the recurrence score against the criteria of England et al and the classification of de Perrot et al. AUC = area under the curve. See Figure 1 legend for expansion of other abbreviation.
See this image and copyright information in PMC

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