S Pasquali1, A Gronchi2, D Strauss3, S Bonvalot4, L Jeys5, S Stacchiotti6, A Hayes3, C Honore4, P Collini7, S L Renne7, N Alexander3, R J Grimer5, D Callegaro2, V P Sumathi8, D Gourevitch1, A Desai9. 1. Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK. 2. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian, Milan 20133, Italy. 3. Sarcoma Unit, Department of Surgery, Royal Marsden NHS Foundation Trust, Fulham Rd, London SW3 6JJ, UK. 4. Department of Surgical Oncology, Institut Gustave Roussy, Rue Edouard Vaillant, 94800 Villejuif, France. 5. Department of Surgery, Royal Orthopedic Hospital, Bristol Rd S, Birmingham B31 2AP, UK. 6. Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian, Milan 20133, Italy. 7. Department of Diagnostic Pathology and Laboratory Medicine, IRCCS Istituto Nazionale dei Tumori, via Venezian, Milan 20133, Italy. 8. Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital, Bristol Rd S, Birmingham B31 2AP, UK. 9. Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK. Electronic address: anant.desai@uhb.nhs.uk.
Abstract
BACKGROUND: Extra-pleural and extra-meningeal solitary fibrous tumour (SFT) is a rare sarcoma histotype curable with surgery in the majority of patients. The behaviour of these tumours ranges from indolent/very low grade to malignant/high grade but it is still not possible to accurately predict prognosis after surgery. We have investigated a multi-centre series to stratify the risk of recurrence to patients with SFTs. METHODS: We retrospectively analysed the data from 243 patients who underwent surgery (2002-2011) at four sarcoma referral centres. RESULTS: Upon univariate analysis, hypercellularity, atypia, necrosis, high mitotic rate (ie >4 mitoses/10 HPF) were associated with both disease-free and overall survival. Surgical margins were a significant prognostic factor for disease-free (P = 0.007) but not for overall survival. Unexpectedly, larger tumour size was associated with a better prognosis (P = 0.038) and fewer recurrences (P = 0.024). Upon multivariable analysis, high mitotic rate (hazard ratio, HR = 2.85, P = 0.002), cellular atypia (HR = 1.62, P = 0.015) and hypercellularity (HR = 1.82, P = 0.031) were significantly associated with recurrences. A SFT recurrence score has been provided to stratify risk of recurrence. CONCLUSION: This study provides a prognostic model to stratify risk of recurrence in patients with resectable SFTs. This allows clinician to decide on an optimal follow-up strategy and to select patients that may benefit from adjuvant treatments. Crown
BACKGROUND:Extra-pleural and extra-meningeal solitary fibrous tumour (SFT) is a rare sarcoma histotype curable with surgery in the majority of patients. The behaviour of these tumours ranges from indolent/very low grade to malignant/high grade but it is still not possible to accurately predict prognosis after surgery. We have investigated a multi-centre series to stratify the risk of recurrence to patients with SFTs. METHODS: We retrospectively analysed the data from 243 patients who underwent surgery (2002-2011) at four sarcoma referral centres. RESULTS: Upon univariate analysis, hypercellularity, atypia, necrosis, high mitotic rate (ie >4 mitoses/10 HPF) were associated with both disease-free and overall survival. Surgical margins were a significant prognostic factor for disease-free (P = 0.007) but not for overall survival. Unexpectedly, larger tumour size was associated with a better prognosis (P = 0.038) and fewer recurrences (P = 0.024). Upon multivariable analysis, high mitotic rate (hazard ratio, HR = 2.85, P = 0.002), cellular atypia (HR = 1.62, P = 0.015) and hypercellularity (HR = 1.82, P = 0.031) were significantly associated with recurrences. A SFT recurrence score has been provided to stratify risk of recurrence. CONCLUSION: This study provides a prognostic model to stratify risk of recurrence in patients with resectable SFTs. This allows clinician to decide on an optimal follow-up strategy and to select patients that may benefit from adjuvant treatments. Crown
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