Paulino Arnold C
Department of Radiation Oncology, The University of Iowa College of Medicine, Iowa City, Iowa, USA.
Am J Clin Oncol. 2004 Apr;27(2):122-7. doi: 10.1097/01.coc.0000047130.91699.dc.
From 1970 to 1999, 44 patients with synovial sarcoma were seen at the University of Iowa. Tumor size was > or = 5 cm in 24 (55%). Histologic classification was biphasic in 26 (59%) and monophasic in 18 (41%). Seven patients (16%) had distant metastasis at initial presentation. For the 37 nonmetastatic patients, local treatment consisted of wide local excision in 29 and amputation in 8; chemotherapy was administered to 10. For the 29 who underwent wide local excision, microscopic resection margins were negative in 18 and positive in 11; 19 received postoperative radiotherapy. The 5-, 10-, and 20-year overall survival rates for the nonmetastatic group were 65.6%, 45.5%, and 37.8%. On multivariate analysis using age as a continuous covariate, younger age (p = 0.028), biphasic histology (p = 0.014), and extremity sites treated with limb-sparing surgery (p = 0.001) were found to be predictors of a better overall survival. No local failures were found after 5 years from initial diagnosis. On multivariate analysis, tumor location at an extremity site was the only variable marginally found to have a better local control (p = 0.065). Of the 19 patients who developed distant metastasis, 5 (26%) failed >5 years and 2 (11%) failed >15 years of follow-up. Younger age, biphasic histology, and extremity sites were found to have a better survival outcome. Late distant relapses can occur with synovial sarcoma.
1970年至1999年期间，爱荷华大学共收治44例滑膜肉瘤患者。肿瘤大小≥5 cm者24例（55%）。组织学分类中，双相型26例（59%），单相型18例（41%）。7例患者（16%）初诊时即有远处转移。对于37例无转移患者，局部治疗包括29例行广泛局部切除，8例行截肢；10例接受化疗。在29例行广泛局部切除的患者中，显微镜下切除边缘阴性者18例，阳性者11例；19例接受术后放疗。无转移组的5年、10年和20年总生存率分别为65.6%、45.5%和37.8%。多因素分析将年龄作为连续协变量，结果显示年龄较小（p = 0.028）、双相组织学类型（p = 0.014）以及采用保肢手术治疗的四肢部位（p = 0.001）是总生存率较好的预测因素。自初始诊断后5年未发现局部复发。多因素分析显示，四肢部位的肿瘤位置是唯一在局部控制方面略有优势的变量（p = 0.
