Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
Department of Musculoskeletal Tumor, First Affiliated Hospital of Shenzhen University, Second People's Hospital, Shenzhen, China.
BMC Cancer. 2021 Jul 3;21(1):773. doi: 10.1186/s12885-021-08485-1.
Synovial sarcoma is an aggressive but chemosensitive soft-tissue tumor. We retrospectively analyzed the efficacy of perioperative chemotherapy for synovial sarcoma with data from the nationwide database, Bone and Soft Tissue Tumor Registry in Japan.
This study included 316 patients diagnosed with synovial sarcoma between 2006 and 2012. Oncologic outcomes were analyzed using a Cox-hazard regression model. Moreover, the effects of perioperative chemotherapy on outcomes were evaluated using a matched-pair analysis. The oncologic outcomes of patients who did or did not receive chemotherapy were compared (cx + and cx-).
Multivariate analysis revealed significant correlations of age (over 40, hazard ratio [HR] = 0.61, p = 0.043), margin status (marginal resection, HR = 0.18, p < 0.001 and intralesional resection, HR = 0.30, p = 0.013 versus wide resection) with overall survival; surgical margin type (marginal resection, HR = 0.14, p = 0.001 and intralesional resection, HR = 0.09, p = 0.035 versus wide resection) with local recurrence; and postoperative local recurrence (HR = 0.30, p = 0.027) and surgical margin (marginal resection, HR = 0.31, p = 0.023 versus wide resection) with distant relapse-free survival. Before propensity score matching, perioperative chemotherapy was mainly administered for young patients and patients with deeper tumor locations, larger tumors, more advanced-stage disease, and trunk location. The 3-year overall survival, local control, and distant relapse-free survival rates were 79.8%/89.3% (HR = 0.64, p = 0.114), 89.6%/93.0% (HR = 0.37, p = 0.171) and 71.4%/84.5% (HR = 0.60, p = 0.089) in the cx+/cx- groups, respectively. After propensity score matching, 152 patients were selected such that the patient demographics were nearly identical in both groups. The 3-year overall survival, local control, and distant relapse-free survival rates were 71.5%/86.0% (HR = 0.48, p = 0.055), 92.5%/93.3% (HR = 0.51, p = 0.436) and 68.4%/83.9% (HR = 0.47, p = 0.046) in the cx+/cx- groups, respectively.
This large-sample study indicated that the margin status and postoperative disease control were associated directly or indirectly with improved oncologic outcomes. However, the efficacy of perioperative chemotherapy for survival outcomes in synovial sarcoma patients was not proven in this Japanese database analysis.
滑膜肉瘤是一种侵袭性但对化疗敏感的软组织肿瘤。我们回顾性分析了来自日本全国骨与软组织肿瘤登记处的数据，以评估滑膜肉瘤围手术期化疗的疗效。
本研究纳入了 2006 年至 2012 年间诊断为滑膜肉瘤的 316 例患者。采用 Cox 风险回归模型分析肿瘤学结局。此外，还通过配对分析评估了围手术期化疗对结局的影响。比较了接受（cx+）和未接受（cx-）化疗的患者的肿瘤学结局。
多因素分析显示，年龄（≥40 岁，风险比 [HR] = 0.61，p = 0.043）、切缘状态（边缘性切除，HR = 0.18，p < 0.001 和局部切除，HR = 0.30，p = 0.013 与广泛切除）与总生存相关；手术切缘类型（边缘性切除，HR = 0.14，p = 0.001 和局部切除，HR = 0.09，p = 0.035 与广泛切除）与局部复发相关；术后局部复发（HR = 0.30，p = 0.027）和手术切缘（边缘性切除，HR = 0.31，p = 0.023 与广泛切除）与远处无复发生存相关。在进行倾向评分匹配之前，围手术期化疗主要用于年轻患者和肿瘤位置较深、肿瘤较大、分期较晚以及位于躯干的患者。cx+/cx-组的 3 年总生存率、局部控制率和远处无复发生存率分别为 79.8%/89.3%（HR = 0.64，p = 0.114）、89.6%/93.0%（HR = 0.37，p = 0.171）和 71.4%/84.5%（HR = 0.60，p = 0.089）。进行倾向评分匹配后，选择了 152 名患者，使两组患者的人口统计学特征几乎相同。cx+/cx-组的 3 年总生存率、局部控制率和远处无复发生存率分别为 71.5%/86.0%（HR = 0.48，p = 0.055）、92.5%/93.3%（HR = 0.51，p = 0.436）和 68.4%/83.9%（HR = 0.47，p = 0.046）。
这项大样本研究表明，切缘状态和术后疾病控制与肿瘤学结局的改善直接或间接相关。然而，在本日本数据库分析中，围手术期化疗对滑膜肉瘤患者生存结局的疗效并未得到证实。
