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

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Title: Prognostic factors of the synovial sarcoma of the extremities: imaging does matter.
Authors: Tordjman, Mickael1 mickael_tordjman@hotmail.com, Honoré, Charles2, Crombé, Amandine3, Bouhamama, Amine4, Feydy, Antoine1, Dercle, Laurent5, Haddag, Leila6, Bouché, Pierre-Alban7,8, Ngo, Carine9, Le Cesne, Axel10, Blay, Jean-Yves11, Mir, Olivier10, Brahmi, Mehdi11, Martin, Charlotte1, Karanian, Marie12, Ammari, Samy6, Kind, Michele3, Audard, Virginie13, Le Loarer, François14, Rabiee, Behnam15
Source: European Radiology. Feb2023, Vol. 33 Issue 2, p1162-1173. 12p. 2 Color Photographs, 1 Diagram, 3 Charts, 1 Graph.
Subjects: Synovial cyst, Overall survival, Magnetic resonance imaging, Biomarkers, Calcification
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. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22European+Radiology%22&quot;&gt;European Radiology&lt;/searchLink&gt;. Feb2023, Vol. 33 Issue 2, p1162-1173. 12p. 2 Color Photographs, 1 Diagram, 3 Charts, 1 Graph.
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  Data: 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 &#177; 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 &#177; 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 &lt; 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. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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