Originally published as JCO Early Release 10.1200/JCO.2004.11.093 on September 13 2004

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Histologic Grade, But Not SYT-SSX Fusion Type, Is an Important Prognostic Factor in Patients With Synovial Sarcoma: A Multicenter, Retrospective Analysis

From the University Institutes of Pathology of Lausanne, Geneva, Berne, and Basel, Switzerland; Bergonié Institute and University of Bordeaux II, Bordeaux; Gustave Roussy Institute, Villejuif; François-Baclesse Cancer Center, Caen; Léon-Bérard Cancer Center, Lyon; Georges-François-Leclerc Cancer Center, Dijon; René-Huguenin Cancer Center, Saint-Cloud, France; and Jules-Bordet Institute, Brussels, Belgium

Address reprint requests to Louis Guillou, MD, Institut Universitaire de Pathologie, rue du Bugnon 25, 1011 Lausanne, Suisse; e-mail: louis.guillou{at}chuv.hospvd.ch

PURPOSE: To assess the prognostic value of SYT-SSX fusion type, in comparison with other factors, in a population of 165 patients with synovial sarcoma (SS).

PATIENTS AND METHODS: Data on 165 patients with SS (141 with localized disease at diagnosis) were studied retrospectively. The following parameters were examined for their potential prognostic value: age at diagnosis, sex, tumor site (extremities v proximal/truncal), size, histology, mitotic count, necrosis, histologic grade (Fédération Nationale des Centres de Lutte Contre le Cancer system), stage (1997 tumor-node-metastasis system classification), surgical margin status (assessed histologically), and fusion type (SYT-SSX1 v SYT-SSX2). Median follow-up time was 37 months (range, 2 to 302 months).

RESULTS: Among those patients with localized disease at diagnosis, median and 5-year disease-specific survivals (DSS) for the SYT-SSX1 and SYT-SSX2 subgroups were 126 months and 67.4% versus 82 months and 63.2%, respectively (P = .12). Median and 5-year metastasis-free survivals (MFS) were 84 months and 54.2% for SYT-SSX1 versus 50 months and 47.6% for SYT-SSX2 (P = .76). Univariate analyses showed that high histologic grade (grade 3), high mitotic count ( 10 mitoses/10 high-power fields), stage III disease, size greater than 7 cm, tumor necrosis, and presence of areas of poorly differentiated morphology were significant adverse prognostic factors for DSS and MFS, whereas SYT-SSX fusion type, tumor histology (biphasic v monophasic), and patient sex were not. Age greater than 35 years adversely affected DSS but not MFS. In multivariate analyses, histologic grade was the most significant prognostic factor for both DSS and MFS.

CONCLUSION: For patients with localized SS, histologic grade but not SYT-SSX fusion type is a strong predictor of survival.

Supported by a grant from the Fondation Pour La Lutte Contre Le Cancer, Zürich, Switzerland.

Presented in part at the US and Canadian Academy of Pathology meeting, Washington, DC, March 22-28, 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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