What is the prognosis of malignant solitary fibrous tumors (SFTs) of the pleura?

Updated: Dec 25, 2019
  • Author: Joseph F Tomashefski, Jr, MD; more...
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Answer

In a series by Schirosi et al, the median overall survival and disease-free survival in patients with SFT were 70 and 60 months, respectively. [10] In a population-based study of patients with malignant SFT, Milano et al found the 1-year, 5-year, and overall survival were 87%, 49%, and 4.6 years, respectively. [87]

Complete surgical excision via thoracoscopy or thoracotomy is the mainstay of therapy, which is curative in most SFTs. Complete excision with tumor-free margins is, moreover, the most important prognostic marker. [10] Prognosis does not always correlate with the histological appearance of the tumor.

In a series by England et al, 45% of 82 patients with histologically malignant tumors were cured of disease. Malignant tumors with prolonged survival tended to be pedunculated or well circumscribed and were completely excised surgically. Recurrence following surgery is more frequent in malignant than in benign SFTs. [9]

In a multivariate analysis of numerous pathologic features, Schirosi et al found that only immunohistochemical high p53 expression and tumor necrosis correlated significantly with overall survival and disease-free survival, respectively. [10]

Huang and Huang noted that factors associated with SFT aggressiveness include mitotic figures of more than 4/10 high-power fields (HPFs), TERT promoter, and/or TP53 mutations. [7]


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