Tordjman Mickael, Honoré Charles, Crombé Amandine, Bouhamama Amine, Feydy Antoine, Dercle Laurent, Haddag Leila, Bouché Pierre-Alban, Ngo Carine, Le Cesne Axel, Blay Jean-Yves, Mir Olivier, Brahmi Mehdi, Martin Charlotte, Karanian Marie, Ammari Samy, Kind Michele, Audard Virginie, Le Loarer François, Rabiee Behnam, Italiano Antoine, Boudou-Rouquette Pascaline, Biau David, Balleyguier Corinne, Larousserie Frederique, Drapé Jean-Luc, Mihoubi Fadila
Department of Radiology, Hopital Cochin, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.
Department of Surgery, Gustave Roussy Cancer campus, Villejuif, France.
Eur Radiol. 2023 Feb;33(2):1162-1173. doi: 10.1007/s00330-022-09049-y. Epub 2022 Aug 18.
Synovial sarcomas (SS) of the extremities are rare soft tissue sarcomas that are more common in young adults. We deciphered the imaging phenotype of SS with the aim to determine if imaging could provide an incremental value to currently known prognostic factors (PF)-age and histological grade-to predict long-term overall survival (OS).
This retrospective multicenter study included consecutive pediatric and adult patients with synovial sarcomas of the extremities from December 2002 to August 2020. Inclusion criteria were (i) a follow-up greater than 5 years and (ii) available pre-therapeutic MRI. A subset analysis included MRI and CT-scan. Clinical, pathological, and imaging variables were collected in all patients. The primary endpoint was to evaluate the association of these variables with OS using univariate and multivariate Cox regressions.
Out of 428 patients screened for eligibility, 98 patients (mean age: 37.1 ± 15.2 years) were included (MRI: n = 98/98, CT scan: n = 34/98; 35%). The median OS was 75.25 months (IQR = 55.50-109.12) and thirty-six patients (n = 36/98;37%) died during follow-up. The recurrence rate was 12.2% (n =12/98). SS lesions were mostly grade 2 (57/98; 58%). On MRI, SS had a mean long-axis diameter of 67.5 ± 38.3 mm. On CT scan, 44% (15/34) were calcified. Grade (hazard ratio [HR] = 2.71; 95%CI = 1.30-5.66; p = 0.008), size of the lesions evaluated on MRI (HR = 1.02; 95% CI = 1.01-1.03; p < 0.001), and calcifications on CT scan (HR = 0.10; 95% CI = 0.02-0.50; p = 0.005) were independent PF of OS.
This study demonstrated that imaging biomarkers can be used to predict long-term outcome in patients with SS. Strikingly, the presence of calcifications on CT scan is associated with favorable outcome and provides an incremental value over existing PF such as age, grade, and size.
• Beyond its diagnostic value, MRI is a pre-operative prognostic tool in synovial sarcomas of the extremities since the size of the lesion is an important prognostic factor. • Calcifications on CT scans are independently and significantly associated with prolonged overall survival.
四肢滑膜肉瘤（SS）是一种罕见的软组织肉瘤，在年轻人中更为常见。我们对SS的影像表型进行了解析，旨在确定影像检查是否能为目前已知的预后因素（PF）——年龄和组织学分级——提供额外价值，以预测长期总生存期（OS）。
这项回顾性多中心研究纳入了2002年12月至2020年8月期间连续的患有四肢滑膜肉瘤的儿童和成人患者。纳入标准为：（i）随访时间超过5年；（ii）有术前MRI检查资料。一项亚组分析包括MRI和CT扫描。收集了所有患者的临床、病理和影像变量。主要终点是使用单因素和多因素Cox回归评估这些变量与总生存期的相关性。
在428名筛查合格的患者中，98名患者（平均年龄：37.1±15.2岁）被纳入研究（MRI：n = 98/98，CT扫描：n = 34/98；35%）。中位总生存期为75.25个月（四分位间距=55.50 - 109.12），36名患者（n = 36/98；37%）在随访期间死亡。复发率为12.2%（n = 12/98）。SS病变大多为2级（57/98；58%）。在MRI上，SS的平均长轴直径为67.5±38.3mm。在CT扫描中，44%（15/34）有钙化。分级（风险比[HR]=2.71；95%置信区间=1.30 - 5.66；p = 0.008）、MRI评估的病变大小（HR = 1.02；95%置信区间=1.01 - 1.03；p < 0.001）以及CT扫描上的钙化（HR = 0.10；95%置信区间=0.02 - 0.50；p = 0.005）是总生存期的独立预后因素。
本研究表明，影像生物标志物可用于预测SS患者的长期预后。引人注目的是，CT扫描上钙化的存在与良好预后相关，并且相对于年龄、分级和大小等现有预后因素提供了额外价值。
• 除了其诊断价值外，MRI是四肢滑膜肉瘤的术前预后评估工具，因为病变大小是一个重要的预后因素。• CT扫描上的钙化与总生存期延长独立且显著相关。
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