Annals of Surgical Oncology

, Volume 24, Issue 13, pp 3865–3871 | Cite as

Size and Location are the Most Important Risk Factors for Malignant Behavior in Resected Solitary Fibrous Tumors

  • Sepideh Gholami
  • Michael R. Cassidy
  • Amanda Kirane
  • Deborah Kuk
  • Bhumika Zanchelli
  • Christina R. Antonescu
  • Samuel Singer
  • Murray BrennanEmail author
Bone and Soft Tissue Sarcomas



While previously thought to be clinically indolent, recent data suggest significant late metastatic capacity of solitary fibrous tumors (SFTs). We define prognostic factors for recurrence and disease-specific death (DSD) in resected primary SFTs.


Resected primary SFTs from 1982 to 2015 were identified from a prospective, single institutional database. Risk factors for local (LR) and distant recurrence (DR), and DSD were assessed using competing risk analysis.


A total of 219 patients with median follow-up of 6.1 (0.1–22) years were included. Five- and 10-year cumulative DSD was 9 and 11%, respectively. Size greater than the median 8 cm, gender, location, and complete gross resection were significantly associated with DSD (p < 0.05). Five- and 10-year cumulative risk (CR) of LR was 4 and 7%, whereas 5- and 10-year CR of DR was 13 and 16%, respectively. LR was associated with location (p = 0.02) and tumor size (p = 0.02), and DR was associated with size (p < 0.01). Histopathologic classification did not predict long-term behavior with both malignant and benign tumors demonstrating capacity for DR and associated death. Tumors in the thoracic cavity and abdomen/retroperitoneum presented the greatest risk of DR (16 and 27% 10-year CR). On multivariate analysis, size ≥ 8 cm (hazard ratio 2.89, p = 0.05) and tumor location in chest or abdominal/retroperitoneal cavity (hazard ratio 2.68, p = 0.01) significantly impacted DSD.


Recurrence is highly associated with DSD and events occur as late as 16 years after initial presentation, including in patients with initially considered benign tumors. Patients with large (≥ 8 cm) tumors in the chest or abdominal/retroperitoneal cavity are at greatest risk.



This study was supported in part by NIH/NCI P30 CA008748 (Cancer Center Support Grant).

Supplementary material

10434_2017_6092_MOESM1_ESM.docx (41 kb)
Supplementary material 1 (DOCX 40 kb)


  1. 1.
    Hanau CA, Miettinen M. Solitary fibrous tumor: histological and immunohistochemical spectrum of benign and malignant variants presenting at different sites. Hum Pathol. 1995;26(4):440–49.CrossRefPubMedGoogle Scholar
  2. 2.
    Fukunaga M, Naganuma H, Nikaido T, Harada T, Ushigome S. Extrapleural solitary fibrous tumor: a report of seven cases. Mod Pathol. 1997;10(5):443–50.PubMedGoogle Scholar
  3. 3.
    Nielsen GP, O’Connell JX, Dickersin GR, Rosenberg AE. Solitary fibrous tumor of soft tissue: a report of 15 cases, including 5 malignant examples with light microscopic, immunohistochemical, and ultrastructural data. Mod Pathol. 1997;10(10):1028–37.PubMedGoogle Scholar
  4. 4.
    Vallat-Decouvelaere A V, Dry SM, Fletcher CD. Atypical and malignant solitary fibrous tumors in extrathoracic locations: evidence of their comparability to intra-thoracic tumors. Am J Surg Pathol. 1998;22(12):1501–11.CrossRefPubMedGoogle Scholar
  5. 5.
    Brunnemann RB, Ro JY, Ordonez NG, Mooney J, El-Naggar AK, Ayala AG. Extrapleural solitary fibrous tumor: a clinicopathologic study of 24 cases. Mod Pathol. 1999;12(11):1034–42.PubMedGoogle Scholar
  6. 6.
    Tan MCB, Brennan MF, Kuk D, Agaram NP, Antonescu CR, Qin L-X, et al. Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma. Ann Surg. 2015.Google Scholar
  7. 7.
    Demicco EG, Park MS, Araujo DM, Fox PS, Bassett RL, Pollock RE, et al. Solitary fibrous tumor: a clinicopathological study of 110 cases and proposed risk assessment model. Mod Pathol. 2012;25(10):1298–1306.CrossRefPubMedGoogle Scholar
  8. 8.
    Gold JS, Antonescu CR, Hajdu C, Ferrone CR, Hussain M, Lewis JJ, et al. Clinicopathologic correlates of solitary fibrous tumors. Cancer. 2002;94(4):1057–68.CrossRefPubMedGoogle Scholar
  9. 9.
    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):640–58.CrossRefPubMedGoogle Scholar
  10. 10.
    Goldman SM, Davidson AJ, Neal J. Retroperitoneal and pelvic hemangiopericytomas: clinical, radiologic, and pathologic correlation. Radiology. 1988;168(1):13–17.CrossRefPubMedGoogle Scholar
  11. 11.
    McMaster MJ, Soule EH, Ivins JC. Hemangiopericytoma. A clinicopathologic study and long-term followup of 60 patients. Cancer. 1975;36(6):2232–44.CrossRefPubMedGoogle Scholar
  12. 12.
    Insabato L, Siano M, Somma A, Gentile R, Santangelo M, Pettinato G. Extrapleural solitary fibrous tumor: a clinicopathologic study of 19 cases. Int J Surg Pathol. 2009;17(3):250–54.CrossRefPubMedGoogle Scholar
  13. 13.
    Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control. 2006;13(4):264–9.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Sepideh Gholami
    • 1
  • Michael R. Cassidy
    • 1
  • Amanda Kirane
    • 2
  • Deborah Kuk
    • 3
  • Bhumika Zanchelli
    • 1
  • Christina R. Antonescu
    • 4
  • Samuel Singer
    • 1
  • Murray Brennan
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryUniversity of California – Davis Medical CenterSacramentoUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of PathologyMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations