title: Synovial sarcoma: a clinicopathologic, staging, and prognostic assessment.
abstract: OBJECTIVE
  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 > or = 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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sarcoma Unit, Royal Marsden Hospital, London, United Kingdom. ajspillane@ozemail.com.au
authors.forename: A J
authors.initials: AJ
authors.lastname: Spillane
authors.forename: R
authors.initials: R
authors.lastname: A'Hern
authors.forename: I R
authors.initials: IR
authors.lastname: Judson
authors.forename: C
authors.initials: C
authors.lastname: Fisher
authors.forename: J M
authors.initials: JM
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013584:Sarcoma, Synovial / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome