Abstract
Background Solitary fibrous tumours of the pleura (SFTP), or pleural fibromas, are rare tumours that generally, but not universally, follow a benign course. Surgical resection is the standard treatment, but there are no evidence-based guidelines regarding the management of these tumours.
Methods Five databases were searched from inception to April 1, 2019 for studies reporting on SFTP management.
Results Twenty-seven studies met the inclusion criteria (1542 patients, all non-comparative case series); 98% of these patients underwent resection and all SFTP included were pathologically diagnosed. 394 out of 1299 cases (30.5%, 95% CI 27.8–32.8%) were malignant with recurrence rates of between 0% and 42.9%. A pleural effusion was always associated with a negative outcome, but no other features were consistently reported to have negative associations. Preoperative biopsies incorrectly reported malignant histology in two studies. Over 25% of cases of recurrence occurred when a complete (R0) resection had been achieved. The first recurrence occurred >5 years after the initial resection in at least 23% of cases.
Conclusions There is strong evidence to support long-term surveillance after surgical resection of SFTP, even where a complete (R0) resection has been achieved; however, there is no clear evidence to inform clinicians regarding the selection of patients who should undergo resection. The rates of malignant SFTP and SFTP recurrence are higher than previously reported. Only those that were pathologically diagnosed or resected were included, which may bias the data towards more aggressive tumours. Data collection on radiologically diagnosed SFTP is required to draw conclusions regarding the timing and need for intervention.
Abstract
Long-term surveillance should be undertaken after a resection of solitary fibrous tumours of the pleura but further work is needed to determine which patients are likely to follow a malignant clinical course to decide timing and necessity of a resection https://bit.ly/2U10SaA
Footnotes
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Authors contributions: R.M. Mercer was responsible for initial draft preparation and revision. R.M. Mercer, C. Wigston and R. Banka were responsible for data acquisition. All authors were responsible for reviewing and approving the final manuscript. R.M. Mercer and N.M. Rahman are responsible for the overall content as guarantors.
Data availability: All data are already in the public domain.
Conflict of interest: R.M. Mercer has nothing to disclose.
Conflict of interest: C. Wigston has nothing to disclose.
Conflict of interest: R. Banka has nothing to disclose.
Conflict of interest: G. Cardillo has nothing to disclose.
Conflict of interest: R. Benamore has nothing to disclose.
Conflict of interest: G. Cardillo has nothing to disclose.
Conflict of interest: R. Asciak has nothing to disclose.
Conflict of interest: M. Hassan has nothing to disclose.
Conflict of interest: R.J. Hallifax has nothing to disclose.
Conflict of interest: L. Wing has nothing to disclose.
Conflict of interest: E.O. Bedawi has nothing to disclose.
Conflict of interest: N.A. Maskell reports an unrestricted research grant from Rocket and Becton Dickinson for IPC plus HiSPEC and REDUCE studies, and sat on the advisory board for cook medical.
Conflict of interest: E. Harriss has nothing to disclose.
Conflict of interest: R.F. Miller reports personal fees for a nonpromotional lecture on clinical aspects of HIV infection from Gilead outside the submitted work.
Conflict of interest: N.J. Rahman reports grants and personal fees from Rocket Medical UK, grants from BD USA, and personal fees from Lung therapeutics USA, outside the submitted work.
Support statement: No external funding was sought or required in relation to this analysis, its interpretation, and in the writing of this manuscript. R.J. Hallifax is funded by an NIHR Clinical Lectureship. R.F. Miller is supported by CNWL and Royal Free London NHS Foundation Trusts. N.M. Rahman is supported by the NIHR Oxford Biomedical Research Centre.
- Received February 4, 2020.
- Accepted May 26, 2020.
- Copyright ©ERS 2020
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