title: Management of the primary intraosseous synovial sarcoma of the jaws: be careful of the surgical margin.
abstract: OBJECTIVE
  Synovial sarcoma (SS) is extremely rare in the jaws, and only 8 cases have been reported worldwide. The specific aims of this study were to report 15 cases of primary intraosseous SS (PISS) and analyze the histologic features and outcome-related prognostic factors.
  
  
  METHODS
  Data from patients diagnosed with PISS from 2004 to 2013 were collected in this retrospective study. Patient characteristics (primary location, histologic subtype, tumor size, and surgical margin) were defined as predictor variables. Local recurrence and tumor-related death were outcome variables. The association of tumor-related outcomes with patient characteristics was analyzed using Kaplan-Meier and Cox regression statistics. Other clinical and pathologic characteristics were summarized as a third category of variables for further analysis.
  
  
  RESULTS
  This study examined 15 cases (women, n = 10; men, n = 5) with a mean age at diagnosis of 35 years. There was no imbalance in the distribution of primary SS locations (maxilla, n = 7; mandible, n = 8). Six patients (40%) developed local recurrence and 4 patients (26.7%) had a tumor-related death. The 5-year local recurrence-free survival (LRFS) and overall survival rates were 57% and 69.1%, respectively. The strong statistical association of surgical margin with 5-year LRFS rate was shown by univariate (P = .01) and multivariate (hazard ratio = 7.598; P = .028) analyses.
  
  
  CONCLUSIONS
  PISS is extremely rare in the jaw. Immunohistochemical analysis played an important role in the diagnosis of PISS. The surgical margin showed a strong association with local recurrence. Thus, ideal surgical margins should be achieved during surgery to obtain better local control.
authors.affiliation: Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhonglong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Shufang
authors.initials: S
authors.lastname: Jin
authors.affiliation: Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Shuiting
authors.initials: S
authors.lastname: Fu
authors.affiliation: Attending Physician, Department of Oral Pathology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Professor, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: yuehe@sjtu.edu.cn.
authors.forename: Yue
authors.initials: Y
authors.lastname: He
mesh_terms: D000071443:12E7 Antigen; D000293:Adolescent; D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D002423:Cause of Death; D015815:Cell Adhesion Molecules / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D018396:Mucin-1 / Q000032:analysis; D037981:Neck Dissection; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013584:Sarcoma, Synovial / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D014746:Vimentin / Q000032:analysis; D055815:Young Adult
chemical_list: D000071443:12E7 Antigen; D015703:Antigens, CD; C061828:CD99 protein, human; D015815:Cell Adhesion Molecules; D018396:Mucin-1; D019253:Proto-Oncogene Proteins c-bcl-2; D014746:Vimentin; D007633:Keratins