Synovial Sarcoma: A Clinicopathologic, Staging, and Prognostic Assessment

• DOI: 10.1200/jco.2000.18.22.3794
• Publication Date: 2017-02-24T07:10:13Z
• Authors: Andrew J. Spillane; Roger A’Hern; Ian R. Judson; Cyril Fisher; J. Meirion Thomas
• Keywords: Adult; Aged, 80 and over; Male; 0301 basic medicine; Leg; Adolescent; Databases, Factual; Soft Tissue Neoplasms; Middle Aged; Prognosis; Survival Analysis; Disease-Free Survival; 3. Good health; Sarcoma, Synovial; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Humans; Female; Prospective Studies; Child; Aged; Neoplasm Staging; Retrospective Studies

PURPOSE: Synovial sarcoma (SS) is a common soft tissue sarcoma (STS) with a propensity for young adults and notable sensitivity to chemotherapy (CT). This study provides a current clinicopathologic, staging, and prognostic assessment for SS. The problems with the current American Joint Committee for Cancer (AJCC) Staging System in relation to SS are discussed. METHODS: Review of a prospective database supplemented by retrospective data. RESULTS: One hundred fifty patients were assessed; median age was 30 years and median follow-up was 52 months. Overall actuarial 5-year survival rate was 57%. Size trend, but not a cutoff of less than 5 cm versus ≥ 5 cm, was a prognostic indicator (P < .001). The current AJCC/International Union Against Cancer Staging System differentiated prognosis less well than the recently proposed Royal Marsden Hospital Staging System. Age greater than 20 years at diagnosis implied worse prognosis. A local recurrence event was associated with a worse survival (P < .001). Therapeutic CT was administered to 55 patients. Eleven of 19 patients had an objective response to a combination of ifosfamide and doxorubicin. Four cases had complete response after CT. Twenty-one patients had pulmonary metastasectomy, with an actuarial 5-year survival rate of 23%. CONCLUSION: SS tends to affect young people. In this subtype of STS, size trend is the most significant influence on stage and hence survival; however, smaller SSs have an unexpectedly poor prognosis. Adequate local control may affect survival. SS is often chemosensitive, and given its poor prognosis, multicenter trials of adjuvant therapy are warranted.