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Tapias Score for Predicting Recurrences in Resected Solitary Fibrous Tumor of the PleuraScoring in Solitary Fibrous Tumor of the Pleura: Controversial Points and Future Perspectives Emerging From an External Validation FREE TO VIEW

Filippo Lococo, MD; Giacomo Cusumano, MD, PhD; Stefano Margaritora, PhD; Giuseppe Cardillo, MD; Pierluigi Filosso, MD, FCCP; Alfredo Cesario, MD
Author and Funding Information

From the Unit of Thoracic Surgery (Dr Lococo) and Head-International Research Activities Office (Dr Cesario), IRCCS-Arcispedale Santa Maria Nuova; General Thoracic Surgery (Dr Cusumano), “Vittorio Emanuele-Policlinico” Hospital; Department of General Thoracic Surgery (Dr Margaritora), Catholic University of the Sacred Heart; Unit of Thoracic Surgery (Dr Cardillo), C. Forlanini Hospital, Azienda Ospedaliera San Camillo-Forlanini Hospital; and Unit of Thoracic Surgery (Dr Filosso), University of Turin.

CORRESPONDENCE TO: Filippo Lococo, MD, Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy 42123; e-mail: filippo_lococo@yahoo.it


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):e115-e116. doi:10.1378/chest.14-2697
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To the Editor:

Solitary fibrous tumor of the pleura (SFTP) is uncommon and has uncertain and unpredictable prognosis. Rarely attempted, the standardization of prognostic criteria has, so far, failed.1,2 The effort from Tapias et al3 recently reported in CHEST (January 2015) is, therefore, very welcome. By first proposing4 and subsequently validating3 a scoring system able to predict the recurrence after (radical) surgical resection for SFTP, they have provided a benchmark for discussion on the issue. Inspired by this, we have analyzed data from our multicentric malignant SFTP database,5 testing the accuracy of the “Tapias score.”

Among 50 male patients with SFTP, 43 were eligible.3 The Tapias score (0–6) was as follows: n = 3, 2 points; n = 7, 3 points; n = 13, 4 points; n = 18, 5 points; and n = 2, 6 points. Tapias score = 0 was not recorded. With a cutoff ≥ 3,3,4 40 patients (93%) were labeled as high risk for recurrence, and three (7%) were labeled as low risk. The Cox regression analysis was reanalyzed, exploring the value of Tapias score in predicting recurrence or death (Table 1). We registered at follow-up 12 recurrences (30%) in the high-risk group vs none in the low-risk group (P = .06), confirming the usefulness of the Tapias score as a predictor of recurrence. In addition, malignant pleural effusion and chest wall invasion significantly increased the risk of recurrence (P = .03 and .007, respectively). The completeness of resection was the only independent factor influencing the prognosis on multivariate analysis (P = .01).

Table Graphic Jump Location
TABLE 1 ]  Cox Regression Analysis of Time to Recurrence and Time to Death

HR = hazard ratio.

a 

Significance at P < .05.

What clearly emerges from this comparison is that the number of recurrences observed in the two clinical series (nine cases in the Tapias et al3 study and 12 in our series) is too low to represent a robust basis for a score system analysis as suggested by the wide ranges in CIs in both analyses. Moreover, the population investigated in Tapias et al3 was not completely representative of the biologic spectrum of such neoplasms, whereas 70% of all patients were low-risk subjects (relapse, 8%). More aggressive cases of SFTP were present in our study, with a higher percentage of recurrences (12 cases, 27.9%).

Consequently, we strongly believe that the Tapias score represents a remarkable step toward a better comprehension of such rare neoplasms and an excellent basis to further generate a more accurate score system analysis on larger and more homogeneous datasets of patients, with the number of recurrences as the principal determinant of the sample size. As well, we believe that other clinical features (eg, chest wall invasion, malignant pleural effusion) probably deserve more attention in prognostic stratification after radical surgery.

References

England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases. Am J Surg Pathol. 1989;13(8):640-658. [CrossRef] [PubMed]
 
de Perrot M, Fischer S, Bründler MA, Sekine Y, Keshavjee S. Solitary fibrous tumors of the pleura. Ann Thorac Surg. 2002;74(1):285-293. [CrossRef] [PubMed]
 
Tapias LF, Mercier O, Ghigna MR, et al. Validation of a scoring system to predict recurrence of resected solitary fibrous tumors of the pleura. Chest. 2015;147(1):216-223. [CrossRef] [PubMed]
 
Tapias LF, Mino-Kenudson M, Lee H, et al. Risk factor analysis for the recurrence of resected solitary fibrous tumours of the pleura: a 33-year experience and proposal for a scoring system. Eur J Cardiothorac Surg. 2013;44(1):111-117. [CrossRef] [PubMed]
 
Lococo F, Cesario A, Cardillo G, et al. Malignant solitary fibrous tumors of the pleura: retrospective review of a multicenter series. J Thorac Oncol. 2012;7(11):1698-1706. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
TABLE 1 ]  Cox Regression Analysis of Time to Recurrence and Time to Death

HR = hazard ratio.

a 

Significance at P < .05.

References

England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases. Am J Surg Pathol. 1989;13(8):640-658. [CrossRef] [PubMed]
 
de Perrot M, Fischer S, Bründler MA, Sekine Y, Keshavjee S. Solitary fibrous tumors of the pleura. Ann Thorac Surg. 2002;74(1):285-293. [CrossRef] [PubMed]
 
Tapias LF, Mercier O, Ghigna MR, et al. Validation of a scoring system to predict recurrence of resected solitary fibrous tumors of the pleura. Chest. 2015;147(1):216-223. [CrossRef] [PubMed]
 
Tapias LF, Mino-Kenudson M, Lee H, et al. Risk factor analysis for the recurrence of resected solitary fibrous tumours of the pleura: a 33-year experience and proposal for a scoring system. Eur J Cardiothorac Surg. 2013;44(1):111-117. [CrossRef] [PubMed]
 
Lococo F, Cesario A, Cardillo G, et al. Malignant solitary fibrous tumors of the pleura: retrospective review of a multicenter series. J Thorac Oncol. 2012;7(11):1698-1706. [CrossRef] [PubMed]
 
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