Synovial sarcoma--towards a simplified approach to prognosis.
BACKGROUND
Synovial sarcoma is a high grade sarcoma that usually occurs in adults. Numerous studies have attempted to identify prognostic factors that might allow more effective treatment for particular subgroups of patients.


METHODS
We studied 25 histologically confirmed cases of synovial sarcoma in an attempt to identify particular patient, tumour or treatment characteristics that might have a prognostic significance using Cox proportional hazards regression modelling to identify differences in survival rates. All patients received their definitive surgical treatment from a single orthopaedic surgeon reducing the likelihood of bias related to variations in surgical technique.


RESULTS
Statistically significant higher survival rates were seen in female patients (P = 0.040) and in patients aged <50 years (P = 0.028). There was also a tendency towards higher survival rates in those cases with upper limb tumours, tumours less than 50 mm in size, and tumours that histologically showed low grade tumour nuclei. Differences in survival were not seen with the percentage of epithelioid, spindled or poorly differentiated areas present, the number of mitoses, or the presence of necrosis. No treatment characteristics were associated with differences in survival.


CONCLUSIONS
The present study has confirmed that male sex and older age are unfavourable prognostic features in synovial sarcoma. Additionally, the histological grade of synovial sarcomas might be more accurately and simply determined based on an assessment of nuclear grade alone.
Campbell
Catherine
C
Department of Anatomical Pathology, Princess Alexandra Hospital, Woolloongabbba, Queensland, Australia. Catherine_Campbell@health.qld.gov.au
Gallagher
John
J
Dickinson
Ian
I
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002454:Cell Differentiation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013584:Sarcoma, Synovial / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D012737:Sex Factors; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D034941:Upper Extremity