Abstract
Much controversy surrounds synovial sarcomas, including prognostic indicators and optimal treatment. This paper reviews these subjects on the 65 cases of synovial sarcoma on the hospital’s database.
At 40 months 3 cases were excluded. 2 on review of the diagnosis and 1 had definitive treatment elsewhere. At 80 months 5 additional patients were lost to follow up.
The Kaplan-Meier 5 year survival rate for all patients in this review was 52.1%. Excluding patients who presented with metastases, this figure rose to 60.1%. All deaths were due to metastatic disease. Univariate analysis showed age of patient and size of tumour to be significant prognostic indicators for survival. Size of tumour only, was a significant predictor of metastatic spread using univariate analysis. Multivariate analysis showed only tumour size to be a significant indicator of survival and metastatic spread.
The local recurrence rate at 5 years was 22.3%. No convincing clinical features were shown to influence the local recurrence rate.
Adjuvant therapy was not shown to influence outcome significantly.
At 80 months follow up the 5 year survival rate increased to 54.9% (SE = 6.9%) and without metastases 61.7% (SE = 7.2%). The significance of established prognostic indicators did not change at final follow up.
The amputation rate was 21%. 3 patients had limb preserving surgery using an endoprosthetic replacement.
Tumour size and metastases appear to be the only consistent prognostic indicators of survival. Endoprosthetic replacement surgery should be considered a surgical option for synovial sarcomas involving bone. Doubling the follow up did not statistically affect survivorship data.
The abstracts were prepared by Mr Roger Tillman. Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
