Evaluation of Alternative Risk Stratification Systems in a Large Series of Solitary Fibrous Tumors with Molecular Findings and Ki-67 Index Data: Do They Improve Risk Assessment?

被引:4
作者
Machado, Isidro [1 ,2 ]
Bujeda, Alvaro Blazquez [3 ]
Giner, Francisco [4 ]
Morales, Maria Gema Nieto [5 ]
Cruz, Julia [1 ]
Lavernia, Javier [6 ]
Navarro, Samuel [7 ]
Ferrandez, Antonio [7 ]
Ruiz-Sauri, Amparo [7 ]
Llombart-Bosch, Antonio [7 ]
机构
[1] Inst Valenciano Oncol, Pathol Dept, Valencia 46009, Spain
[2] Hosp Quiron Salud, Pathol Dept, Patologika Lab, Valencia 46009, Spain
[3] Univ Valencia, Sch Med, Valencia 46009, Spain
[4] Univ Hosp La Fe, Pathol Dept, Valencia 46009, Spain
[5] Univ Valencia, Zool Dept, Valencia 46009, Spain
[6] Inst Valenciano Oncol, Dept Oncol, Valencia 46009, Spain
[7] Univ Valencia, Pathol Dept, Valencia 46009, Spain
关键词
solitary fibrous tumor; risk stratification system; Ki-67; index; TP53; mutation; HTER mutation; overall survival; EXPRESSION; FEATURES; FUSION; NECK; HEAD;
D O I
10.3390/ijms24010439
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
The clinical evolution of solitary fibrous tumors (SFTs) is often uncertain and several risk stratification systems (RSS) have been proposed. The Demicco et al. RSS is the most frequently implemented. In this study we aim to validate two alternative RSS (Sugita et al. and G-Score) using results for the Demicco RSS from a previous study of 97 SFTs. In addition, we aim to determine whether reclassified cases had any distinctive molecular features. As the Sugita et al. system substitutes mitotic count with Ki-67 index we also investigated whether Ki-67 results for tissue microarrays are comparable to those obtained using whole tissue sections. In the present study we detected that many cases classified by Demicco RSS as low-risk were reclassified as intermediate risk using the new system (G-score RSS). Kaplan-Meier survival plots for G-Score RSS showed that the low-risk and intermediate-risk SFTs had a similar evolution that contrasted with the more aggressive high-risk group. Moreover, the similar evolution in both low and intermediate-risk groups occurred despite the G-score system being stricter in classifying low-risk tumors. We observed that Sugita RSS does not provide any better risk stratification in comparison with the Demicco RSS, and testing both RSS in our series produced similar Kaplan-Meier survival data. We found some discordant results when comparing whole sections and the corresponding tissue microarrays samples, finding the hotspot areas easier to locate in whole sections. Forty-one SFTs with initial low-risk assigned by the Demicco RSS were reclassified as intermediate-risk by G-score finding both TP53 and HTER mutations in four cases, only HTER mutation in 11 cases, and only TP53 mutation in 2 cases. All six cases of SFT classified as high-risk by both the Demicco and G-score RSS suffered recurrence/metastasis, and half showed both TP53 and HTER mutations. Five SFTs were categorized as low-risk by both Demicco and G-score, of which 4 cases revealed HTER mutation. Regarding the outcome of these 5 patients, two were lost to follow-up, and one of the remaining three patients suffered recurrence. We believe that although the presence of both TP53 and HTER mutations may confer or be related to poor evolution, the isolated presence of HTER mutation alone would not necessarily be related to poor outcome. The G-score RSS more accurately identified low-risk patients than the other two risk models evaluated in the present series. Late recurrence/metastasis may occasionally be observed even in low-risk SFTs categorized by stricter classification systems such as the G-score RSS. These findings support the possibility that additional, as yet unknown factors may influence the clinical evolution of SFTs. In conclusion, given the possibility of late recurrence, long-term follow-up is recommended for all SFT patients, even in cases classified as low risk by the stricter G-score system. An integration of clinical, radiological, pathological, and molecular findings may improve SFT risk stratification and better predict patient outcome.
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页数:10
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