Guillou Louis, Benhattar Jean, Bonichon Françoise, Gallagher Gabrielle, Terrier Philippe, Stauffer Edouard, Somerhausen Nicolas de Saint Aubain, Michels Jean-Jacques, Jundt Gernot, Vince Dominique Ranchère, Taylor Sophia, Genevay Muriel, Collin Françoise, Trassard Martine, Coindre Jean-Michel
Institut Universitaire de Pathologie, rue du Bugnon 25, 1011 Lausanne, Suisse.
J Clin Oncol. 2004 Oct 15;22(20):4040-50. doi: 10.1200/JCO.2004.11.093. Epub 2004 Sep 13.
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).
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 (Federation 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).
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.
For patients with localized SS, histologic grade but not SYT-SSX fusion type is a strong predictor of survival.
在165例滑膜肉瘤（SS）患者群体中，评估SYT-SSX融合类型与其他因素相比的预后价值。
回顾性研究165例SS患者（141例诊断时为局限性疾病）的数据。检查以下参数的潜在预后价值：诊断时年龄、性别、肿瘤部位（四肢与近端/躯干）、大小、组织学、有丝分裂计数、坏死、组织学分级（法国国立癌症中心联合会系统）、分期（1997年肿瘤-淋巴结-转移系统分类）、手术切缘状态（组织学评估）以及融合类型（SYT-SSX1与SYT-SSX2）。中位随访时间为37个月（范围2至302个月）。
在诊断时为局限性疾病的患者中，SYT-SSX1和SYT-SSX2亚组的中位疾病特异性生存期（DSS）和5年DSS分别为126个月和67.4%，以及82个月和63.2%（P = 0.12）。SYT-SSX1的中位无转移生存期（MFS）和5年MFS为84个月和54.2%，而SYT-SSX2为50个月和47.6%（P = 0.76）。单因素分析显示，高组织学分级（3级）、高有丝分裂计数（≥10个有丝分裂/10个高倍视野）、Ⅲ期疾病、大小大于7 cm、肿瘤坏死以及存在低分化形态区域是DSS和MFS的显著不良预后因素，而SYT-SSX融合类型、肿瘤组织学（双相与单相）以及患者性别则不是。年龄大于35岁对DSS有不利影响，但对MFS无影响。多因素分析中，组织学分级是DSS和MFS最显著的预后因素。
对于局限性SS患者，组织学分级而非SYT-SSX融合类型是生存的有力预测指标。
