title: Synovial sarcoma of the extremities: prognostic factors for 20 nonmetastatic cases and a new histologic grading system with prognostic significance.
abstract: OBJECTIVE
  To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance.
  
  
  METHODS
  The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed.
  
  
  RESULTS
  The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up.
  
  
  CONCLUSIONS
  The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).
authors.affiliation: Orthopedic Oncology Group, Department of Orthopedics, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil. andre.baptista@uol.com.br
authors.forename: André Mathias
authors.initials: AM
authors.lastname: Baptista
authors.forename: Olavo Pires de
authors.initials: OP
authors.lastname: Camargo
authors.forename: Alberto Tesconi
authors.initials: AT
authors.lastname: Croci
authors.forename: Cláudia Regina G C M de
authors.initials: CR
authors.lastname: Oliveira
authors.forename: Raymundo Soares de
authors.initials: RS
authors.lastname: Azevedo Neto
authors.forename: Marcelo Abrantes
authors.initials: MA
authors.lastname: Giannotti
authors.forename: Marcelo Tadeu
authors.initials: MT
authors.lastname: Caiero
authors.forename: Telma Murias dos
authors.initials: TM
authors.lastname: Santos
authors.forename: Márcia Datz
authors.initials: MD
authors.lastname: Abadi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D005121:Extremities / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000145:classification / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000145:classification / Q000401:mortality / Q000473:pathology*; D013584:Sarcoma, Synovial / Q000145:classification / Q000401:mortality / Q000473:pathology; D017678:Sex Distribution; D012983:Soft Tissue Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*