Much controversy surrounds synovial sarcomas, including prognostic indicators and optimal treatment. This paper reviews these subjects on the 65 cases of synovial sarcoma on the hospital’s database.

At 40 months 3 cases were excluded. 2 on review of the diagnosis and 1 had definitive treatment elsewhere. At 80 months 5 additional patients were lost to follow up.

The Kaplan-Meier 5 year survival rate for all patients in this review was 52.1%. Excluding patients who presented with metastases, this figure rose to 60.1%. All deaths were due to metastatic disease. Univariate analysis showed age of patient and size of tumour to be significant prognostic indicators for survival. Size of tumour only, was a significant predictor of metastatic spread using univariate analysis. Multivariate analysis showed only tumour size to be a significant indicator of survival and metastatic spread.

The local recurrence rate at 5 years was 22.3%. No convincing clinical features were shown to influence the local recurrence rate.

Adjuvant therapy was not shown to influence outcome significantly.

At 80 months follow up the 5 year survival rate increased to 54.9% (SE = 6.9%) and without metastases 61.7% (SE = 7.2%). The significance of established prognostic indicators did not change at final follow up.

The amputation rate was 21%. 3 patients had limb preserving surgery using an endoprosthetic replacement.

Tumour size and metastases appear to be the only consistent prognostic indicators of survival. Endoprosthetic replacement surgery should be considered a surgical option for synovial sarcomas involving bone. Doubling the follow up did not statistically affect survivorship data.