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Original research
Multivariate evaluation of prognostic markers in synovial sarcoma
  1. Ana-Belen Larque1,
  2. Santiago Lozano-Calderon2,
  3. Gregory M Cote3,
  4. Yen-Lin Chen4,
  5. Yin P Hung5,
  6. Vikram Deshpande5,
  7. G Petur Nielsen5,
  8. Ivan Chebib5
  1. 1 Department of Pathology, University of Barcelona, Barcelona, Spain
  2. 2 Department of Orthopaedic Surgery, Massachuestts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Ivan Chebib, James Homer Wright Pathology Laboratories, Boston, MA 02114, USA; ichebib{at}partners.org

Abstract

Aims Synovial sarcoma (SS) is an aggressive neoplasm but with varied clinical outcomes despite standard treatment protocols. Several clinicopathological features and immunohistochemical stains have been proposed as prognostic markers in SS. The aim of this study was to evaluate SS from a single institution for prognostically relevant clinicopathological and immunohistochemical factors.

Methods We identified a single-institution cohort of SS with follow-up. Clinical and pathological factors examined included age, sex, tumour location, AJCC (American Joint Committee on Cancer) stage, tumour size, grade and status of surgical margins. Immunohistochemical staining for p16, p53, RB1, MYC, PTEN (phosphatase and tensin homologue), β-catenin, MDM2 and Ki67 proliferative index was performed on tissue microarray. Cox proportional hazard model was used for multivariate assessment of overall survival (OS) and disease-free survival (DFS).

Results 133 patients with SS met the inclusion criteria for our cohort, with 100 having complete dataset for all study covariates. On Cox regression multivariate analysis, location (axial vs extremity, p<0.001), AJCC stage (p<0.001), p16 expression (≥75%, p=0.021) were significantly associated with worse OS, whereas PTEN intensity (score 2, p<0.001) and p53 expression (null/≥75%, p=0.013) were correlated with improved OS. For DFS analysis, location (axial vs extremity, p=0.030), tumour size (≥5 cm, p=0.009) and MYC expression (≥33%, p=0.013) were associated with inferior outcome. Only PTEN intensity (score 2, p<0.001) correlated with improved DFS.

Conclusions In reviewing numerous clinicopathological and immunohistochemical markers, this study shows that location, AJCC stage, p16, p53 and PTEN expression were prognostically significant in multivariate analysis for OS in a uniformly treated SS cohort. Location, tumour size, MYC and PTEN expression were significantly associated with DFS.

  • diagnostic techniques and procedures
  • sarcoma
  • immunohistochemistry

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jcp-2022-208518

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Handling editor Runjan Chetty.

    • Contributors A-BL, IC, YPH, VD, GPN: Planning and conception. A-BL, IA-C, VD: Study design and development of TMA. A-BL, IC, SL-C, GMC, Y-LC: Acquisition of data. A-BL, IC: Analysis and interpretation of data. A-BL, IC, YPH, GMC, SL-C: Manuscript construction. IC: overall content as the guarantor.

    • Funding This investigation was performed through an unrestricted research grant from the Saquish Foundation.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.