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Prognostic factors of the synovial sarcoma of the extremities: imaging does matter

  • Oncology
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Abstract

Objectives

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).

Methods

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.

Results

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.

Conclusions

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.

Key points

• 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.

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Abbreviations

BMI:

Body mass index

FNCLCC:

Fédération Nationale des Centres de Lutte Contre le Cancer

LFS:

Local recurrence-free survival

MFS:

Metastasis-free survival

MRI:

Magnetic resonance imaging

OS:

Overall survival

PF:

Prognostic factor

SS:

Synovial sarcoma

WI:

Weighted imaging

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Hopital Cochin, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France

    Mickael Tordjman, Antoine Feydy, Charlotte Martin, Jean-Luc Drapé & Fadila Mihoubi

  2. Department of Surgery, Gustave Roussy Cancer campus, Villejuif, France

    Charles Honoré

  3. Department of Radiology, Institut Bergonié, Bordeaux, France

    Amandine Crombé & Michele Kind

  4. Department of Radiology, Centre Léon Bérard, Lyon, France

    Amine Bouhamama

  5. Department of Radiology, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA

    Laurent Dercle

  6. Department of Radiology, Gustave Roussy Cancer campus, Villejuif, France

    Leila Haddag, Samy Ammari & Corinne Balleyguier

  7. Department of Orthopaedic Surgery, Hopital Cochin, APHP, Paris, France

    Pierre-Alban Bouché & David Biau

  8. Department of Biostatistics and Medical Information, Hopital Saint Louis, APHP, Université de Paris, ECSTRA Team, UMR U1153, INSERM, Paris, France

    Pierre-Alban Bouché

  9. Department of Pathology, Gustave Roussy Cancer campus, Villejuif, France

    Carine Ngo

  10. Department of Oncology, Gustave Roussy Cancer campus, Villejuif, France

    Axel Le Cesne & Olivier Mir

  11. Department of Oncology, Centre Léon Bérard, Lyon, France

    Jean-Yves Blay & Mehdi Brahmi

  12. Department of Pathology, Centre Léon Bérard, Lyon, France

    Marie Karanian

  13. Department of Pathology, Hopital Cochin, APHP, Paris, France

    Virginie Audard & Frederique Larousserie

  14. Department of Pathology, Institut Bergonié, Bordeaux, France

    François Le Loarer

  15. Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

    Behnam Rabiee

  16. Department of Oncology, Institut Bergonié, Bordeaux, France

    Antoine Italiano

  17. Department of Oncology, Hopital Cochin, APHP, Paris, France

    Pascaline Boudou-Rouquette

Authors
  1. Mickael Tordjman
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  2. Charles Honoré
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Corresponding author

Correspondence to Mickael Tordjman.

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Guarantor

The scientific guarantor of this publication is Mickael Tordjman.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Pierre-Alban Bouché and David Biau kindly provided statistical advice for this manuscript. They have significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients or family of deceased) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

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Tordjman, M., Honoré, C., Crombé, A. et al. Prognostic factors of the synovial sarcoma of the extremities: imaging does matter. Eur Radiol 33, 1162–1173 (2023). https://doi.org/10.1007/s00330-022-09049-y

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