Mickael Tordjman1, Charles Honoré2, Amandine Crombé3, Amine Bouhamama4, Antoine Feydy5, Laurent Dercle6, Leila Haddag7, Pierre-Alban Bouché8,9, Carine Ngo10, Axel Le Cesne11, Jean-Yves Blay12, Olivier Mir11, Mehdi Brahmi12, Charlotte Martin5, Marie Karanian13, Samy Ammari7, Michele Kind3, Virginie Audard14, François Le Loarer15, Behnam Rabiee16, Antoine Italiano17, Pascaline Boudou-Rouquette18, David Biau8, Corinne Balleyguier7, Frederique Larousserie14, Jean-Luc Drapé5, Fadila Mihoubi5. 1. Department of Radiology, Hopital Cochin, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France. mickael_tordjman@hotmail.com. 2. Department of Surgery, Gustave Roussy Cancer campus, Villejuif, France. 3. Department of Radiology, Institut Bergonié, Bordeaux, France. 4. Department of Radiology, Centre Léon Bérard, Lyon, France. 5. Department of Radiology, Hopital Cochin, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France. 6. Department of Radiology, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA. 7. Department of Radiology, Gustave Roussy Cancer campus, Villejuif, France. 8. Department of Orthopaedic Surgery, Hopital Cochin, APHP, Paris, France. 9. Department of Biostatistics and Medical Information, Hopital Saint Louis, APHP, Université de Paris, ECSTRA Team, UMR U1153, INSERM, Paris, France. 10. Department of Pathology, Gustave Roussy Cancer campus, Villejuif, France. 11. Department of Oncology, Gustave Roussy Cancer campus, Villejuif, France. 12. Department of Oncology, Centre Léon Bérard, Lyon, France. 13. Department of Pathology, Centre Léon Bérard, Lyon, France. 14. Department of Pathology, Hopital Cochin, APHP, Paris, France. 15. Department of Pathology, Institut Bergonié, Bordeaux, France. 16. Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA. 17. Department of Oncology, Institut Bergonié, Bordeaux, France. 18. Department of Oncology, Hopital Cochin, APHP, Paris, France.
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.
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.
Authors: A H Krieg; F Hefti; B M Speth; G Jundt; L Guillou; U G Exner; A R von Hochstetter; M D Cserhati; B Fuchs; E Mouhsine; A Kaelin; F M Klenke; K A Siebenrock Journal: Ann Oncol Date: 2010-08-17 Impact factor: 32.976
Authors: Kenneth R Gundle; Lisa Kafchinski; Sanjay Gupta; Anthony M Griffin; Brendan C Dickson; Peter W Chung; Charles N Catton; Brian O'Sullivan; Jay S Wunder; Peter C Ferguson Journal: J Clin Oncol Date: 2018-01-18 Impact factor: 44.544
Authors: André Mathias Baptista; Olavo Pires de Camargo; Alberto Tesconi Croci; Cláudia Regina G C M de Oliveira; Raymundo Soares de Azevedo Neto; Marcelo Abrantes Giannotti; Marcelo Tadeu Caiero; Telma Murias dos Santos; Márcia Datz Abadi Journal: Clinics (Sao Paulo) Date: 2006-10 Impact factor: 2.365