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Luis F. Tapias, MD; Michael Lanuti, MD, FCCP
Author and Funding Information

From the Division of Thoracic Surgery, Massachusetts General Hospital.

CORRESPONDENCE TO: Michael Lanuti, MD, FCCP, Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit St, Blake 1570, Boston, MA 02114; e-mail: mlanuti@mgh.harvard.edu


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):e116-e117. doi:10.1378/chest.14-2892
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To the Editor:

We sincerely thank Dr Lococo and colleagues for their comments on our recent article in CHEST1 validating a scoring system to predict recurrence after complete resection of solitary fibrous tumors of the pleura (SFTPs). We commend the expeditious effort of applying the score to a multiinstitutional population of patients with resected “malignant” SFTPs.2 The results appear to further support the scoring system as a useful clinical tool that outperformed historical criteria (ie, England’s criteria), even when applied to a higher risk population harboring a malignant phenotype of SFTPs.

We agree with the authors’ comment that the number of events in our study (ie, SFTP recurrences) is too low to represent a robust basis for a score-system analysis. However, the low incidence of this neoplasm3 precludes the accumulation of large patient samples hampering prospective studies. Published literature consists mostly of single-institution retrospective case series, with no standardization of prognostic criteria. In spite of these limitations, it is our intention to provide a basis to organize the evaluation of oncologic outcomes of patients undergoing surgical treatment of SFTP. Including the population of Lococo et al,2 the proposed scoring system has now been applied to three independent cohorts of patients accounting for a total of 215 subjects with SFTPs.1,2,4 In all cases, it has performed well in terms of its capacity to classify patients according to their risk of SFTP recurrence after complete surgical resection.

We respectfully disagree with the statement that the population studied in the external validation cohort1 does not represent all of the biologic spectrum of SFTP. While it is true that we excluded patients with multifocal and metastatic disease, incompletely resected SFTPs, and those medically unfit to undergo surgery, we included all patients treated at a reference surgical center. One would expect that this would capture most cases as they spontaneously occur in the hospital’s area of influence.

Finally, we agree with the comment that other variables deserve more attention in the prognostic stratification of patients with SFTP. In concordance with their observation, in our score development cohort4 we found that the presence of a pleural effusion, as well as a symptomatic presentation, and a Ki67 proliferation index > 10% were associated with SFTP recurrence on univariate analysis. Unfortunately, these variables could not be included in our regression models given the paucity of events and our small sample size. We believe that the predictive ability of the present score can be improved by incorporating additional clinical variables, but especially, molecular parameters, while analyzing larger multiinstitutional populations.

References

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]
 
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]
 
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]
 
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]
 

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References

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]
 
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]
 
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]
 
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]
 
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