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Analytical Cellular Pathology
Volume 16, Issue 1, Pages 45-62
http://dx.doi.org/10.1155/1998/545906

Synovial sarcoma. Evaluation of Prognosis with Emphasis on the Study of DNA Ploidy and Proliferation (PCNA and Ki-67) Markers

José M. Lopes,1 Einar Hannisdal,2 Bodil Bjerkehagen,1 Øyvind S. Bruland,2 Håvard E. Danielsen,2 Erik O. Pettersend,4 Manuel Sobrinho-Simões,1 and Jahn M. Nesland3

1Unit of Molecular Pathology, IPATIMUP, Medical Faculty, Porto, Portugal
2Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital and Institute for Cancer Research, Montebello, Oslo, Norway
3Department of Pathology, The Norwegian Radium Hospital and Institute for Cancer Research, Montebello, Oslo, Norway
4Department of Tissue Culture, The Norwegian Radium Hospital and Institute for Cancer Research, Montebello, Oslo, Norway

Received 17 September 1996; Accepted 2 January 1998

Copyright © 1998 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Controversy still exists regarding the validity of parameters commonly used in the evaluation of prognosis of patients with synovial sarcoma (SS). Forty-nine cases of previously untreated primary SS (23 females and 26 males, ranging in age from 7 to 81, with 31 tumors located in the lower extremity, 8 at the upper extremity and 10 at the trunchus), without regional lymph-node or distant metastases were studied. We investigated the relationship between (flow and image) DNA cytometry, proliferation activity, clinicopathologic parameters, and relapse-free and overall survival of the patients. The prognostic value of gender, age, duration of symptoms, location, compartmentalization, size, adequacy of surgical margins, residual tumor, adjuvant therapy, histologic subtype, extent of necrosis, glandular differentiation, calcification, and extent of hemangiopericytic areas, mitotic rate, amount of mast cells, blood vessel invasion, histologic (UICC and NCI) grades, DNA ploidy, percentage of cells in S and S+G2 phases, PCNA and Ki-67 labeling indices (LI), and TNM (UICC) stage of the tumors, were evaluated by univariate and multivariate (Cox hazard model) analyses. Short duration of symptoms (<12 months), biphasic SS, scarcity of mast cells (<10/10 HPF), high mitotic rate (≥10/10 HPF), high histologic grade (grade 3), high PCNA-LI (≥20%), high Ki-67-LI (≥10%), DNA aneuploidy, and advanced TNM stage (stage III) were features associated with significantly shorter relapse-free and overall 5-year survival rates in the univariate analyses. Scarcity of mast cells, high mitotic rate, or high PCNA-LI were significant predictors of poor survival, in addition to TNM stage in the multivariate analyses. The amount of mast cells was inversely correlated with mitotic rate and PCNA-LI. Scarcity of mast cells, high mitotic rate, or high PCNA-LI are factors associated with poor prognosis, in addition to advanced TNM stage in patients with localized SS