Hasegawa T, Yokoyama R, Matsuno Y, Shimoda T, Hirohashi S
Pathology Division, National Cancer Center Research Institute and Hospital, Tokyo, Japan.
Hum Pathol. 2001 Mar;32(3):257-63. doi: 10.1053/hupa.2001.22764.
Synovial sarcoma, which has a wide spectrum of biologic behavior, warrants accurate grading to assess the patient's prognosis. We studied the clinicopathologic and immunohistochemical features of 44 cases of synovial sarcoma in patients treated primarily or secondarily at the National Cancer Center, Tokyo, to identify independent prognostic factors. There were local recurrences in 16 patients (36%), and 25 (57%) developed metastases, primarily to the lungs. The estimated cumulative 5-year and 10-year survival rates were 68% and 41%, respectively. Variables associated with an adverse outcome included tumor size > 6.7 cm; initial treatment outside the National Cancer Center; poorly differentiated subtype; high nuclear atypia; mitosis count > 27/10 high-power fields; tumor necrosis; absence of stromal calcification; nuclear expression of beta-catenin, which was found in 25 cases (57%); Ki-67 (MIB-1) index > 27%; and histologic grade 3. Nuclear accumulation of beta-catenin as a cell-signaling event may play an important role in the progression of synovial sarcoma and therefore might be predictive of short survival. However, multivariate analysis clearly showed that only histologic grade, as defined by using categorized variables for the MIB-1 index and tumor necrosis, was an independent prognostic factor. Most variables were correlated with lung metastasis and histologic grade. High-grade synovial sarcoma assessed by a histologic grading system based on the proliferative activity of the neoplastic cells can be viewed as high risk with the patients most likely to die of disease within 10 years after surgery and in need of improved chemotherapy. HUM PATHOL 32:257-263.
滑膜肉瘤具有广泛的生物学行为谱，需要准确分级以评估患者预后。我们研究了44例在东京国立癌症中心接受初次或二次治疗的滑膜肉瘤患者的临床病理和免疫组化特征，以确定独立的预后因素。16例患者（36%）出现局部复发，25例（57%）发生转移，主要转移至肺部。估计的5年和10年累积生存率分别为68%和41%。与不良预后相关的变量包括肿瘤大小>6.7 cm；在国立癌症中心以外接受初始治疗；低分化亚型；核异型性高；有丝分裂计数>27/10高倍视野；肿瘤坏死；无基质钙化；β-连环蛋白的核表达（25例，57%）；Ki-67（MIB-1）指数>27%；以及组织学3级。β-连环蛋白作为一种细胞信号事件的核积累可能在滑膜肉瘤的进展中起重要作用，因此可能预示生存期短。然而，多变量分析清楚地表明，仅根据MIB-1指数和肿瘤坏死的分类变量定义的组织学分级是独立的预后因素。大多数变量与肺转移和组织学分级相关。通过基于肿瘤细胞增殖活性的组织学分级系统评估的高级别滑膜肉瘤可被视为高风险，患者最有可能在手术后10年内死于疾病，需要改进化疗。《人类病理学》32:257 - 263。
