Prognostic factors in localized primary synovial sarcoma: A multicenter study of 128 adult patients

Purpose: To identify most significant and therapeutically relevant prognost ic factors in adults with localized primary synovial sarcomas (SS) and to c onfirm the usefulness of the French Federation of Cancer Centers (FNCLCC) g rading system, the prognostic impact of which has been already proven in so ft tissue sarcomas, Patients and Methods: Data on 128 patients with nonmetastatic SS collected from ct cooperative database by the FNCLCC Sarcoma Group between 1980 and 1 994 were studied retrospectively. Immunohistochemistry was performed at dia gnosis in 77 cases (61%). The tumors were classified as biphasic (n = 45), monophasic fibrous (n = 72), and poorly differentiated (n = 10) subtypes. H istologic grade was determined according to the FNCLCC method, and vascular invasion was assessed in every case. Results: The 5-year disease-specific survival (DSS) rate for this series of patients with localized SS was 62.9% (+/- 9.6% [SD]) with a median follow- up time of 37 months (range, 8 to 141 months), In multivariate analysis, th e adverse risk factors associated with decreased DSS were International Uni on Against Cancer/ American Joint Committee on Cancer stage III/IVA disease , male sex, and truncal tumor locations. For metastasis-free survival (MFS) , disease stage III/IVA, tumor necrosis, and monophasic subtypes were the m ajor factors associated with a less favorable prognosis. Separately, when n ot using disease stage, tumor necrosis, and mitotic activity, histologic gr ade became the most significant prognostic factor for both DSS and MFS. In addition, larger tumors and older patients become associated with a signifi cantly worse prognosis. Independent adverse risk factors for local recurren ce-free survival included histologic grade 3 and truncal tumor location. Conclusion: These data confirm that not all SS present the same severe outc ome. High-risk patients identified on the basis of these parameters may qua lify for an aggressive treatment approach. J Clin Oncol 19:525-534. (C) 200 1 by American Society of Clinical Oncology.