A Synovial Sarcoma-Specific Preoperative Nomogram Supports a Survival Benefit to Ifosfamide-Based Chemotherapy and Improves Risk Stratification for Patients

Abstract

Purpose:To identify prognostic factors related to outcome in 255 patients with synovial sarcoma and to construct a preoperative nomogram to predict the risk of disease-specific death. Design: Between July 1982 and June 2006, 301patients underwent treatment at our institution for primary synovial sarcoma of all anatomic sites and 255 patients with localized disease at presentation were resected with curative intent. Data were collected prospectively and analyzed retrospectively. Results: Five-, 10-, and 15-year disease-specific survival (DSS) was 72%, 60%, and 53%, respectively. Multivariate analysis revealed size and primary tumor site as the only independent adverse predictors of disease-specific death. A nomogram based on preoperative data for surgical patients not receiving anthracycline-ifosfamide (AI) chemotherapy (n = 196) estimates 3-and 5-year DSS with a concordance index of 77.3%. For the first 3 years following diagnosis, the observed DSS for patients treated with AI chemotherapy (n = 59) was greater than that predicted by the preoperative nomogram based on patients not receiving AI chemotherapy. SYT-SSX fusion transcript data were available for 132 patients. Multivariate analysis of this subset showed that SYT-SSX1fusion type was predictive of early, but not late, distant recurrence. Conclusion: Size and location govern prognosis in primary synovial sarcoma resected with curative intent. A nomogram based on preoperative variables provides individualized patient survival estimates and shows an early survival benefit to chemotherapy that may dissipate over time. This nomogram may improve decision-making with regards to selecting patients most likely to benefit from neoadjuvant/adjuvant chemotherapy.

The Role of 18F-FDG PET/CT as a Prognostic Factor in Patients with Synovial Sarcoma

“…The efficacy and role of chemotherapy in synovial sarcoma are still uncertain [4,39,40]. A previous study reported that 5-year event-free survival was not different in patients with synovial sarcoma who received or did not receive NAC (62.6 vs. 71.5 %) [41].…”

A Comparison of Fine-needle Aspiration, Core Biopsy, and Surgical Biopsy in the Diagnosis of Extremity Soft Tissue Masses

“…A block of tissue allows the pathologist to examine tumor architecture and cellular interrelation, improving the diagnosis of histologic subtype and grade compared to FNA [13,19,56]. Other advantages of core biopsy, as with FNA, include speed, convenience, decreased cost (average $1106 per case), minimal morbidity, minimal contamination, and a 0.1% to 1.1% complication rate; disadvantages are also similar to FNA and include limited sampling and inaccessibility of some masses (secondary to size, depth, density, or location) [8,24,25,40,50,53,56].…”

Chemotherapy Influences the Pseudocapsule Composition in Soft Tissue Sarcomas

“…Adjuvant radiotherapy has been shown to decrease rates of local recurrence; however, the role of adjuvant chemotherapy has been less clear [1, 4-6, 13, 17]. Local and distant control of certain histological subtypes of STS improves with chemotherapy; however, there are conflicting results regarding the applicability of chemotherapy to STS as a whole [3][4][5]14].…”