title: Metastatic Patterns of Solitary Fibrous Tumors: A Single-Institution Experience.
abstract: OBJECTIVE
  The objective of our study was to evaluate the metastatic patterns and imaging features of solitary fibrous tumors (SFTs).
  
  
  METHODS
  This retrospective study included 139 patients with pathologically proven SFT, 49 of whom developed metastases. Electronic medical records and all available images were reviewed to record the pattern and imaging appearances of metastatic disease, and comparisons of thoracic SFTs and extrathoracic SFTs were also performed. Associations of metastatic spread were studied using univariate and multivariate Cox regression analyses.
  
  
  RESULTS
  A total of 49 (35%) patients developed metastases at a median of 124 months (interquartile range [IQR], 66-195 months) after SFT diagnosis; 11 patients (8%) had metastases at presentation. Of these 49 patients, 40 patients died at a mean of 183 months after diagnosis. The associations with metastatic disease on univariate analysis were tumor size ≥ 10 cm (p = 0.01) and malignant pathology or mitotic count ≥ 4 per 10 high-power fields (HPF) (p < 0.001). Malignant pathology and a mitotic count of ≥ 4 per 10 HPF were also associated with metastatic disease on multivariate analysis (p = 0.01; hazard ratio, 0.22; 95% CI, 0.05-0.73). The most common sites of metastasis were the lungs (30/49, 61%) followed by the pleura (24/49, 49%) and then the liver (20/49, 41%), bones (20/49, 41%), and peritoneum (20/49, 41%). A significantly higher proportion of patients with extrathoracic SFT had metastatic disease (37/139, 27%) compared with those with thoracic SFT (12/139, 9%) (p = 0.003). The overall metastasis-free survival was a median of 117 months (IQR, 33-169 months) in patients with extrathoracic SFT and a median of 120 months (IQR, 82-169 months) in patients with thoracic SFT (p = 0.01).
  
  
  CONCLUSIONS
  A mitotic count of ≥ 4 per 10 HPF or malignant pathology was significantly associated with metastatic disease on both univariate and multivariate analyses. The sites of metastatic disease differed depending on the site of the primary SFT but were most commonly the lung and pleura. Patients with extrathoracic SFT were statistically more likely to develop metastatic disease than those with thoracic SFT.
authors.affiliation: 1 Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Ailbhe C
authors.initials: AC
authors.lastname: O'Neill
authors.affiliation: 1 Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Sree Harsha
authors.initials: SH
authors.lastname: Tirumani
authors.affiliation: 1 Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Woo S
authors.initials: WS
authors.lastname: Do
authors.affiliation: 1 Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Abhishek R
authors.initials: AR
authors.lastname: Keraliya
authors.affiliation: 2 Department of Pathology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Hornick
authors.affiliation: 1 Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Atul B
authors.initials: AB
authors.lastname: Shinagare
authors.affiliation: 1 Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115.
authors.forename: Nikhil H
authors.initials: NH
authors.lastname: Ramaiya
mesh_terms: D001900:Boston / Q000453:epidemiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D012307:Risk Factors; D054364:Solitary Fibrous Tumors / Q000401:mortality / Q000473:pathology* / Q000556:secondary*; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000556:secondary*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
keywords: extrathoracic; metastases; solitary fibrous tumor; thoracic