Criteria of Bergh et al for Low and High Risk Groups in Patients with Synovial Sarcoma

 

Parameters associated with mortality rate:

(1) age

(2) size of tumor

(3) presence of poorly differentiated areas

Parameter	Low Risk Group	High Risk Group
age	< 25 years old	>= 25 years
size of tumor	< 5 cm	>= 5cm
presence of poorly differentiated areas	no	yes

 

NOTE: In the article both groups "AND" the 3 parameters. Since not all patients would fit into these 2 groups precisely, there is either (a) an intermediate risk group, or (b) the high risk group should use "OR". Based on Table 2 page 2604 my guess is that there is an intermediate risk group.

 

Risk Group	Percent with Metastasis	Overall Disease Free Survival
Low Risk	12%	88%
High Risk	86%	18%

 

Types of poorly differentiated tumors:

(1) primitive, small cell type, resembling Ewing's sarcoma

(2) larger cell type with plump, spindled-to-rounded tumor cells with features intermediate between fibroblast-like and epithelioid cells of classical biphasic synovial sarcoma

(3) spindle cell of fascicular type with frequent necrosis, resembling a malignant peripheral nerve sheath tumor

 

Features of poorly differentiated tumors:

(1) high grade appearance

(2) high mitotic activity

(3) nuclear atypia (irregularly dispersed chromatin and conspicuous nucleoli)

 

Local recurrence was associated with a 3.66 fold increase in tumor-related death.

 

Risk factors for local recurrence:

(1) larger size

(2) primary treatment not at a referral center, usually with inadequate primary surgery

 

Risk factors for metastasis:

(1) older age

(2) presence of poorly differentiated areas

(3) presence of necrosis

 

Location of the tumor did not correlate with either local control or survival. The authors felt that the favorable outcome associated with distal tumors in other studies was probably related to smaller size and/or the ability to achieve adequate surgical margins.