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Synovial sarcoma: a clinicopathologic, staging, and prognostic assessment
A J Spillane1, R A'Hern, I R Judson
1Sarcoma Unit, Royal Marsden Hospital, London, United Kingdom. ajspillane@ozemail.com.au
Summary
Synovial sarcoma (SS) affects young adults and shows chemotherapy sensitivity. Size trend impacts prognosis, but smaller tumors may have a worse outlook, warranting further adjuvant therapy trials.
Area of Science:
- Oncology
- Sarcoma Research
Background:
- Synovial sarcoma (SS) is a prevalent soft tissue sarcoma (STS) predominantly affecting young adults.
- SS demonstrates notable sensitivity to chemotherapy (CT).
Purpose of the Study:
- To provide a current clinicopathologic, staging, and prognostic assessment for SS.
- To discuss limitations of the current American Joint Committee for Cancer (AJCC) Staging System for SS.
Main Methods:
- Review of a prospective database augmented with retrospective data.
Main Results:
- A total of 150 patients were analyzed, with a median age of 30 years and median follow-up of 52 months.
- Overall 5-year survival was 57%. A trend in tumor size, not a strict cutoff, was a significant prognostic indicator (P <.001).
- Age over 20 at diagnosis and local recurrence were associated with poorer survival (P <.001). The AJCC staging system showed less prognostic differentiation compared to the Royal Marsden Hospital Staging System.
Conclusions:
- Synovial sarcoma predominantly affects young individuals, with tumor size trend being a key prognostic factor, though smaller tumors present a paradoxically poor prognosis.
- Effective local control appears to influence survival outcomes.
- Given SS's chemosensitivity and poor prognosis, multicenter trials investigating adjuvant therapies are recommended.