SYNOVIAL SARCOMA - PROGNOSTIC-SIGNIFICANCE OF TUMOR SIZE, MARGIN OF RESECTION, AND MITOTIC-ACTIVITY FOR SURVIVAL

Purpose: The present study serves to describe outcomes-based prognosti c variables characteristic of synovial cell sarcoma. Patients and Meth ods: An analysis was performed of a prospectively compiled data base o f 48 consecutive patients with extremity and truncal synovial sarcomas seen between 1966 and 1994. Results: No local recurrences were observ ed among 27 patients who presented with localized primary disease. Pat ients with synovial sarcomas less than 5 cm in size had a cancer-speci fic survival rate at 10 years of 100%, compared with a 10-year surviva l rate of 32% and 0% for those with sarcomas 5 to 10 cm and greater th an 10 cm, respectively (P =.002). Patients with synovial sarcomas with less than 10 mitoses per 10 high-power fields (hpf) had a 10-year can cer-specific survival rate of 46%, compared with a 10-year survival ra te of 14% for those with sarcomas with greater than 10 mitoses per 10 hpf (P =.04). Patients with a clean margin excision of sarcoma were fo und to have a 10-year caneer-specific survival rate of 43%, compared w ith 0% for those with microscopic positive margins (P =.03), Among 14 patients treated with neoadjuvant chemotherapy, seven (50%) had object ive responses. Conclusion: Local control for patients with nonmetastat ic disease was excellent. The overall cancer-specific survival rate fo r patients with localized synovial sarcoma was 34% at 10 years. Primar y tumor size, margin of resection, and mean mitotic activity were prog nostic factors for survival in synovial sarcoma. There was a high obje ctive response rate to treatment with neoadjuvant chemotherapy; howeve r, there were no detectable beneficial effects on survival in the subs et of patients treated with chemotherapy versus nonrandomized patients who received no chemotherapy. Patients with synovial sarcomas greater than or equal to 5 cm in size, microscopic positive margins, and/or m ean mitotic activity greater than 10 mitoses per 10 hpf should be targ eted for new therapeutic studies. (C) 1996 by American Society of Clin ical Oncology.