ASO Author Reflections: What are the Survivorship and Prognostic Factors of Patients with Metastatic Solitary Fibrous Tu
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: What are the Survivorship and Prognostic Factors of Patients with Metastatic Solitary Fibrous Tumors? Hidetatsu Outani, MD, PhD1
, and Takafumi Ueda, MD, PhD2
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; 2Department of Orthopedic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan 1
PAST Solitary fibrous tumor (SFT) is a rare subtype of mesenchymal tumor that harbors NAB2-STAT6 fusion gene and is characterized by its unpredictable malignant behavior. Several risk stratification models have been proposed because of the occurrence of distant metastasis in up to 40% of patients, regardless of the traditional histologic classification.1–3 Among several prognostic factors that comprise risk stratification models, a high mitotic rate ([ 4/10 high power fields) and patient age were reported as the strongest predictors of aggressive behavior in SFTs.4 Nevertheless, an accurate prediction of the malignant potential of SFTs is still challenging. Moreover, clinical outcomes of patients with metastatic SFTs are extremely rare. Factors associated with survival after metastasis and the role of chemotherapy and metastasectomy in this condition are still unknown. PRESENT To evaluate the aforementioned criteria, we conducted a multi-institutional, retrospective study.5 We revealed a longer survival period for metastatic SFT patients with a median survival of 55 months after metastasis and found that the head and neck primary tumor and local recurrence were associated with late metastasis. Furthermore, it was
observed that among the metastatic SFT patients, neither high mitotic rate nor patient age was correlated with survival, but primary tumor location and number of metastases affected the survival. Metastasectomy was the most significant factor associated with survival, but palliative chemotherapy did not affect the survival. FUTURE Our results were affected by the patient selection bias and should be interpreted with caution, due to the retrospective nature of this study. Hopefully, our results will be of great help for physicians in making clinical decisions when treating this disease. International collaborative studies are needed to accumulate the number of patients and elucidate who would benefit from metastasectomy and what is the most effective chemotherapeutic regimen. Additionally, our results did not show a high activity of ongoing palliative chemotherapy; thus, new agents are required to enhance clinical outcomes. Basic research for NAB2-STAT6 fusion gene will deepen our understanding of the molecular mechanism of SFT oncogenesis and might lead to the development of new agents for this disease. The present study provides fundamental data of metastatic SFT patients and would contribute to the development of a clinical trial for this extremely rare disease.
Ó Society of Surgical Oncology 2020
FUNDING No benefits in any form have been received or will be received from a commercial party related
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