SYNOVIAL SARCOMA - EVALUATION OF PROGNOSIS WITH EMPHASIS ON THE STUDYOF DNA-PLOIDY AND PROLIFERATION (PCNA AND KI-67) MARKERS

Controversy still exists regarding the validity of parameters commonly used in the evaluation of prognosis of patients with synovial sarcoma (SS). Forty-nine cases of previously untreated primary SS (23 females and 26 males, ranging in age from 7 to 81, with 31 tumors located in the lower extremity, 8 at the upper extremity and 10 at the trunchus), without regional lymph-node or distant metastases were studied. We in vestigated the relationship between (flow and image) DNA cytometry, pr oliferation activity, clinicopathologic parameters, and relapse-free a nd overall survival of the patients. The prognostic value of gender, a ge, duration of symptoms, location, compartmentalization, size, adequa cy of surgical margins, residual tumor, adjuvant therapy, histologic s ubtype, extent of necrosis, glandular differentiation, calcification, and extent of hemangiopericytic areas, mitotic rate, amount of mast ce lls, blood vessel invasion, histologic (UICC and NCI) grades, DNA ploi dy, percentage of cells in S and S+G2 phases, PCNA and Ki-67 labeling indices (LI),;and TNM (UICC) stage of the tumors, were evaluated by un ivariate and multivariate (Cox hazard model) analyses. Short duration of symptoms (<12 months), biphasic SS, scarcity of mast cells (<10/10 HPF), high mitotic rate (greater than or equal to 10/10 HPF), high his tologic grade (grade 3), high PCNA-LI (greater than or equal to 20%), high Ki-67-LI (greater than or equal to 10%), DNA aneuploidy, and adva nced TNM stage (stage III) were features associated with significantly shorter relapse-free and overall 5-year survival rates in the univari ate analyses. Scarcity of mast cells, high mitotic rate, or high PCNA- LI were significant predictors of poor survival, in addition to TNM st age in the multivariate analyses. The amount of mast cells was inverse ly correlated with mitotic rate and PCNA-LI. Scarcity of mast cells, h igh mitotic rate, or high PCNA-LI are factors associated with poor pro gnosis, in addition to advanced TNM stage in patients with localized S S.