Objective: Pleural solitary fibrous tumours (pSFTs) are mesenchymal neoplasms with usually indolent behaviour, although a subset shows aggressive features with recurrence and metastasis. Due to this unpredictability, the 2020 WHO classification defines pSFTs as tumours with intermediate malignant potential, highlighting the need for reliable prognostic tools. This study compared the prognostic performance of the standard and revised Demicco scores in surgically treated pSFT patients, focusing on survival and recurrence prediction. Methods: In this multicenter retrospective study, patients undergoing surgical resection for pSFTs between 1993 and 2023 at four European thoracic surgery centers were included. All cases underwent centralized pathological review and reclassification according to 2021 WHO criteria. Risk stratification was performed using the standard (4-DC) and revised (n4-DC) Demicco models. Overall survival and recurrence were analysed using Kaplan–Meier and competing-risk methods. Prognostic performance was assessed with multivariable Cox models, Harrell's C-index, and time-dependent AUC. Results: A total of 112 patients were included. Minimally invasive surgery was performed in 80%, achieving R0 resection in 88%. Overall survival at 1, 3, 5, and 10 years was 98%, 87%, 83%, and 70%, respectively. Both models stratified survival effectively, with worse outcomes in intermediate- and high-risk groups. The 10-year cumulative incidence of recurrence was 23%, reaching 50% in high-risk patients and 0% in low-risk patients. The revised model showed superior discrimination for recurrence (C-index 0.813), while survival prediction was comparable. Five-year AUC for recurrence and survival was comparable between the two scores (0.867). Roughly 14% of the cases were rescored (upgraded or downgraded) in the n4-DC. Conclusions: Demicco scores reliably predict outcomes in surgically treated pSFTs. The revised model improves recurrence prediction without significant survival advantage.
Revised demicco score improves prediction of postoperative recurrence in pleural solitary fibrous tumours: A multicenter retrospective study
Faccioli, Eleonora
;Rosa, Ester;Pezzuto, Federica;Comacchio, Giovanni Maria;Lorenzoni, Giulia;Calabrese, Fiorella;Gregori, Dario;Dell'Amore, Andrea
2026
Abstract
Objective: Pleural solitary fibrous tumours (pSFTs) are mesenchymal neoplasms with usually indolent behaviour, although a subset shows aggressive features with recurrence and metastasis. Due to this unpredictability, the 2020 WHO classification defines pSFTs as tumours with intermediate malignant potential, highlighting the need for reliable prognostic tools. This study compared the prognostic performance of the standard and revised Demicco scores in surgically treated pSFT patients, focusing on survival and recurrence prediction. Methods: In this multicenter retrospective study, patients undergoing surgical resection for pSFTs between 1993 and 2023 at four European thoracic surgery centers were included. All cases underwent centralized pathological review and reclassification according to 2021 WHO criteria. Risk stratification was performed using the standard (4-DC) and revised (n4-DC) Demicco models. Overall survival and recurrence were analysed using Kaplan–Meier and competing-risk methods. Prognostic performance was assessed with multivariable Cox models, Harrell's C-index, and time-dependent AUC. Results: A total of 112 patients were included. Minimally invasive surgery was performed in 80%, achieving R0 resection in 88%. Overall survival at 1, 3, 5, and 10 years was 98%, 87%, 83%, and 70%, respectively. Both models stratified survival effectively, with worse outcomes in intermediate- and high-risk groups. The 10-year cumulative incidence of recurrence was 23%, reaching 50% in high-risk patients and 0% in low-risk patients. The revised model showed superior discrimination for recurrence (C-index 0.813), while survival prediction was comparable. Five-year AUC for recurrence and survival was comparable between the two scores (0.867). Roughly 14% of the cases were rescored (upgraded or downgraded) in the n4-DC. Conclusions: Demicco scores reliably predict outcomes in surgically treated pSFTs. The revised model improves recurrence prediction without significant survival advantage.
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