Patel Riddhi R, Delclos George L, DeSantis Stacia M, Cannell Michael B, Lupo Philip J, Bishop Andrew J, Lazar Alexander J, Lin Patrick P, Benjamin Robert S, Patel Shreyaskumar R, Ludwig Joseph, Ravi Vinod, Livingston John Andrew, Somaiah Neeta, Zarzour Maria Alejandra, Conley Anthony P, Araujo Dejka M
Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center.
Department of Epidemiology.
Am J Clin Oncol. 2025 Jan 1;48(1):21-27. doi: 10.1097/COC.0000000000001142. Epub 2024 Sep 3.
We evaluated survival outcomes by primary tumor site in synovial sarcoma (SS) patients with localized and metastatic disease at diagnosis.
We conducted a retrospective review of 504 SS patients diagnosed from 1974 to 2020. Kaplan-Meier method, log-rank test, and Cox-proportional hazards regression were used.
Among 504 patients, 401 (79.6%) presented with localized disease, and 103 (20.4%) with metastases. For patients with localized disease, (1) 5-year OS by tumor site was as follows: 80% (95% CI, 67%-89%) for head/neck, 30% (95% CI, 18%-42%) for intrathoracic, 51% (95% CI, 35%-65%) for abdomen/pelvis, 71% (95% CI, 62%-79%) for proximal-extremity, and 83% (71%, 91%) for distal-extremity. (2) On multivariable analysis, tumor site (compared with proximal-extremity: intrathoracic tumors [HR: 1.95; 95% CI, 1.22-3.16]; hand/foot [HR: 0.52; 95% CI, 0.28-0.97]), tumor size (compared with <5 cm, 5-10 cm [HR: 1.80; 95% CI, 1.14-2.85]; ≥10 cm [HR: 4.37; 95% CI, 2.69-7.11]), and use of neo/adjuvant radiation (HR: 0.54; 95% CI, 0.37-0.79) remained significantly associated with OS. For patients with metastatic disease, (1) 5-year OS was 12% (95% CI, 6%-21%) and (2) the only factor that remained significantly associated with OS on multivariable analysis was surgical resection for the primary tumor (HR: 0.14; 95% CI, 0.08-0.26).
The primary tumor location plays a significant role in predicting outcomes for patients with localized SS. Even though patients present with metastatic disease, surgical resection of the primary tumor improves their survival. These findings are critical for patient counseling and designing a personalized treatment plan that reflects the corresponding outcomes.
我们评估了诊断时患有局限性和转移性疾病的滑膜肉瘤（SS）患者按原发肿瘤部位划分的生存结局。
我们对1974年至2020年诊断的504例SS患者进行了回顾性研究。使用了Kaplan-Meier法、对数秩检验和Cox比例风险回归。
在504例患者中，401例（79.6%）表现为局限性疾病，103例（20.4%）有转移。对于局限性疾病患者，（1）按肿瘤部位划分的5年总生存率如下：头颈部为80%（95%CI，67%-89%），胸腔内为30%（95%CI，18%-42%），腹部/骨盆为51%（95%CI，35%-65%），近端肢体为71%（95%CI，62%-79%），远端肢体为83%（71%，91%）。（2）在多变量分析中，肿瘤部位（与近端肢体相比：胸腔内肿瘤[HR：1.95；95%CI，1.22-3.16]；手/足[HR：0.52；95%CI，0.28-0.97]）、肿瘤大小（与<5 cm相比，5-10 cm[HR：1.80；95%CI，1.14-2.85]；≥10 cm[HR：4.37；95%CI，2.69-7.11]）以及新辅助/辅助放疗的使用（HR：0.54；95%CI，0.37-0.79）仍与总生存率显著相关。对于转移性疾病患者，（1）5年总生存率为12%（95%CI，6%-21%），（2）在多变量分析中唯一与总生存率仍显著相关的因素是原发肿瘤的手术切除（HR：0.14；95%CI，0.08-0.26）。
原发肿瘤位置在预测局限性SS患者的结局中起重要作用。即使患者患有转移性疾病，原发肿瘤的手术切除也能提高其生存率。这些发现对于患者咨询和设计反映相应结局的个性化治疗方案至关重要。
