| ObjectiveThe purpose of this study was to investigate and evaluate the clinical efficacy of surgery-based comprehensive treatment for synovial sarcoma,and the prognostic factors affecting recurrence,metastasis,and survival.Exploring the safety and the clinical efficacy of varied chemotherapy modes for synovial sarcoma.MethodsThe electronic medical record system of Tianjin Cancer Hospital was searched and totally 95 patients who were diagnosed as synovial sarcoma and underwent surgery in Tianjin Cancer Hospital from January 2012 to December 2014 were carefully screened.Information such as patient’s gender,age,KPS scores,primary tumor site,tumor diameter,and the AJCC stage of tumor were collected as well as treatment information including surgery,surgical margin,timing of adjuvant therapy,radiotherapy,chemotherapy(regimen,cycle,neoadjuvant chemotherapy).Patients were followed up by outpatient review or telephone calls to record information of survival,tumor recurrence and metastasis.The follow-up ended on June 30,2018.Indexes including OS,LRFS,DMFS,PFS were calculated and analyzed.Statistical analysis was performed using SPSS 24.0 software.Continuous variable data in accordance with the normal distribution was expressed by the mean or median while counting variable data was expressed as a percentage(%).Kaplan-Meier method and Log-rank test and COX regression model were used to analyze relevant factors of recurrence,metastasis and survival.Efficacy of different modes of chemotherapy were analyzed by Kaplan-Meier method.P values < 0.05 were considered significant.ResultPatients were followed up for 8~296 months with a median follow-up time of 62.0 months.The median OS was 76.0 months(95% CI 67.9-84.1),and 5-year OS rate was 70.7%,10-year OS rate was 32.6%.The median LRFS time was 38(95% CI: 30.8-49.2)months,the 5-year LRFS rate was 33.7%.The median DMFS time of all patients was 44.0(95% CI: 26.3-63.7)months,the 5-year DMFS rate was 45.1%,and the 5-year PFS rate was 22.5%.Univariate and multivariate analysis showed that AJCC staging(p<0.001),primary tumor site(p=0.027),tumor diameter(p=0.015),timing of adjuvant chemotherapy(p=0.004),treatment(p=0.005),presence of recurrence or metastasis(p=0.016)were all independent survival prognostic factor for synovial sarcoma;and primary tumor site(p=0.01)was the only related factor associated with LRFS in this research.Multivariate analysis showed that primary tumor site(p=0.002),AJCC stage(p=0.000)were independent factors influencing tumor metastasis.The median OS time of patients with radiotherapy and non-radiation were 114.0(95% CI 41.7-186.3)and 67.0(95% CI 56.7-77.3)months respectively,and 5-year OS rates were 72.0% and 69.9%,respectively(p= 0.043).The median OS time of patients with chemotherapy was 80.0(95% CI: 73.9-86.1)months,and the 5-year OS rate was 72.6%.For patients who received adjuvant chemotherapy,the median OS time of those with ≥4 but <6 cycles of chemotherapy,and another group of ≥6 cycles were77.0 months and 97.0 months,significantly better than 66.0 months(p=0.015)of those with less than 4 courses.ConclusionSurgery combined with adjuvant chemotherapy or radiotherapy can prolong the OS of adult patients with synovial sarcoma.In addition,an earlier AJCC stage at the first diagnosis,tumor located in limbs or trunk,and tumor diameter <5cm,no recurrence or metastasis occurring,and early postoperative adjuvant therapy do good to a longer overall survival time;patients with tumors on their limbs or trunk had a relatively late recurrence and metastasis.For patients receiving chemotherapy,4-5 cycles works better than <4 cycles,while ≥6 cycles of chemotherapy was most effective.Adequate radiotherapy and full-course chemotherapy after complete tumor resection were recommended for adult patients with synovial sarcoma,and AI regimen may be the first choice for chemotherapy. |
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