Demır Derya, Yaman Banu, Anacak Yavuz, Keçecı Burçin, Kandıloğlu Gülşen, Akalin Taner
Department of Pathology, Manisa State Hospital, MANİSA, TURKEY.
Turk Patoloji Derg. 2014;30(1):55-65. doi: 10.5146/tjpath.2013.01221.
We aimed to determine the prognostic value of bcl-2, c-myc and survivin in synovial sarcoma cases and to evaluate the relationship between the conventional morphological findings with prognosis.
In this study, we evaluated 81 synovial sarcoma cases referred to our tertiary tumor center during a period of 20 years. We applied bcl-2, c-myc and survivin immunohistochemically and investigated the relationship with prognosis for those 65 cases with follow-up. The relationship between the conventional morphological findings (mitosis, necrosis, grade) with prognosis was also investigated.
Five-year disease free survival rate was 44% and ten-year progression free survival rate was 38%, reflecting the aggressive behavior of synovial sarcoma. Tumor grade (according to FNCLCC) was the most significant prognostic input in this study. We obtained a significant difference between grade II (40 cases) and grade III (24 cases) group regarding progression-free survival and overall survival (p < 0.001 and p < 0.001 respectively). Grade II was divided into two groups according to mitotic index and necrosis (grade IIa and IIb) and there was a significant difference between them regarding prognosis (p=0.013 for progression free survival, p=0.003 for overall survival). There was a significant relationship between bcl-2 negative plus focally weak positive cases (9 cases) and focally strong cases (21 cases) and diffuse strong cases (35 cases) (p=0.042 and p=0.016 respectively). There was a significant relation between c-myc negative cases (25 cases) and nuclear positive cases (17 cases) regarding overall survival (p=0.043) and between c-myc negative cases and cytoplasmic positive cases (23 cases) regarding progression free survival (p=0.05). The relation between survivin and prognosis was not significant.
Tumor grade was the most significant prognostic parameter in this study. The grade IIa group (with less than 10 mitoses in 10 HPF, without necrosis) had a better prognosis than both the grade IIb and III groups. The grade IIb group was closer to grade III regarding the prognosis. Bcl-2 and c-myc (nuclear and/or cytoplasmic) immunohistochemical positivity had prognostic value but this finding has to be confirmed by large series.
我们旨在确定bcl-2、c-myc和生存素在滑膜肉瘤病例中的预后价值，并评估传统形态学表现与预后之间的关系。
在本研究中，我们评估了20年间转诊至我们三级肿瘤中心的81例滑膜肉瘤病例。我们采用免疫组织化学方法检测bcl-2、c-myc和生存素，并对65例有随访资料的病例研究其与预后的关系。同时也研究了传统形态学表现（有丝分裂、坏死、分级）与预后之间的关系。
5年无病生存率为44%，10年无进展生存率为38%，这反映了滑膜肉瘤的侵袭性行为。肿瘤分级（根据法国国立癌症中心联合会分级法）是本研究中最显著的预后指标。在无进展生存率和总生存率方面，II级（40例）和III级（24例）组之间存在显著差异（分别为p<0.001和p<0.001）。II级根据有丝分裂指数和坏死情况分为两组（IIa级和IIb级），它们在预后方面存在显著差异（无进展生存率p=0.013，总生存率p=0.003）。bcl-2阴性加局灶弱阳性病例（9例）与局灶强阳性病例（21例）和弥漫强阳性病例（35例）之间存在显著关系（分别为p=0.042和p=0.016）。c-myc阴性病例（25例）与核阳性病例（17例）在总生存率方面存在显著关系（p=0.043），c-myc阴性病例与胞质阳性病例（23例）在无进展生存率方面存在显著关系（p=0.05）。生存素与预后之间的关系不显著。
肿瘤分级是本研究中最显著的预后参数。IIa级组（每10个高倍视野中有丝分裂少于10个且无坏死）的预后优于IIb级和III级组。IIb级组在预后方面更接近III级。bcl-2和c-myc（核和/或胞质）免疫组化阳性具有预后价值，但这一发现有待大样本研究证实。
