TY - JOUR
T1 - Prognostic factors of the synovial sarcoma of the extremities
T2 - imaging does matter
AU - Tordjman, Mickael
AU - Honoré, Charles
AU - Crombé, Amandine
AU - Bouhamama, Amine
AU - Feydy, Antoine
AU - Dercle, Laurent
AU - Haddag, Leila
AU - Bouché, Pierre Alban
AU - Ngo, Carine
AU - Le Cesne, Axel
AU - Blay, Jean Yves
AU - Mir, Olivier
AU - Brahmi, Mehdi
AU - Martin, Charlotte
AU - Karanian, Marie
AU - Ammari, Samy
AU - Kind, Michele
AU - Audard, Virginie
AU - Le Loarer, François
AU - Rabiee, Behnam
AU - Italiano, Antoine
AU - Boudou-Rouquette, Pascaline
AU - Biau, David
AU - Balleyguier, Corinne
AU - Larousserie, Frederique
AU - Drapé, Jean Luc
AU - Mihoubi, Fadila
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to European Society of Radiology.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - 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.
AB - 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.
KW - Magnetic resonance imaging
KW - Prognosis
KW - Sarcoma
UR - http://www.scopus.com/inward/record.url?scp=85136240836&partnerID=8YFLogxK
U2 - 10.1007/s00330-022-09049-y
DO - 10.1007/s00330-022-09049-y
M3 - Article
C2 - 35980435
AN - SCOPUS:85136240836
SN - 0938-7994
VL - 33
SP - 1162
EP - 1173
JO - European Radiology
JF - European Radiology
IS - 2
ER -