17例非典型/恶性孤立性纤维性肿瘤临床病理特征及预后评价

Clinicopathological Features and Prognostic Evaluation of 17 Cases of Atypical/Malignant Solitary Fibrous Tumors

目的探讨非典型/恶性孤立性纤维性肿瘤(SFT)复发转移的临床病理因素。方法收集福建医科大学附属第一医院颅外非典型/恶性SFT病例17例,分析比较临床病理特征中单因素和多因素风险分层模型与肿瘤复发转移的关系。结果非典型/恶性SFT患者17例,获得随访资料15例,其中复发2例,转移3例。肿瘤高核分裂象、坏死、浸润性边界与术后复发转移具有相关性(P<0.05);SFT传统恶性指标(P=0.017)和Georgiesh风险模型(G-score)(P=0.017)对肿瘤预后预测具有统计学意义,优于Demicco多因素风险模型(D-score)。比较G-score和D-score风险分组差异,17例中,13例为同一风险组,差异4例,其中复发转移3例,在G-score中的风险分组均高于D-score分组。SFT相关基因CD 34在高分险组中表达局灶丢失。结论核分裂计数≥4个、坏死、浸润性边界、传统恶性指标>3项与SFT的不良预后有关,相较于单因素,多因素风险模型具有更高的预后预测价值。

Objective It is to investigate the clinicopathological factors of recurrence and metastasis in atypical/malignant solitary fibrous tumor(SFT).Methods Cases of extracerebral atypical/malignant SFT were collected at The First Affiliated Hospital of Fujian Medical University,and the relationship between univariate and multifactorial risk stratification models in clinicopathological characteristics and tumor recurrence and metastasis was analyzed and compared.Results Among the 17 cases of atypical/malignant SFT,follow-up data were obtained in 15 cases,of which 2 cases showed recurrence and 3 cases metastasis.Tumor high mitotic count,necrosis,and infiltrative border were correlated with postoperative recurrence and metastasis(P<0.05).The conventional malignant index of SFT(P=0.017)and the Georgiesh risk model(G-Score)(P=0.017)were statistical significance in predicting tumor prognosis and superior to the Demicco multifactorial risk model(D-Score).Comparing the differences in risk grouping between G-Score and D-Score,there were 13 out of 17 SFT cases in the same risk group.Within the 4 SFT cases in different risk group,3 patients experienced recurrence and metastasis.The risk groups in G-Score are higher than those in D-Score group.Focal loss of SFT related gene CD34 protein expression in high-risk groups.Conclusion Mitotic count more than or equal to 4,necrosis,infiltrative border,and traditional malignant indicators more than 3 were associated with poor prognosis of SFT,and the multivariate risk model had a higher prognostic value compared to univariate.