Key result
Neoadjuvant chemotherapy did not significantly improve 3-year overall survival compared to no chemotherapy in a propensity score-matched cohort of patients with synovial sarcoma (HR 0.83, p=0.563).
Why the study?
Synovial sarcoma is an aggressive but chemosensitive soft-tissue tumor, but the efficacy of neoadjuvant chemotherapy required evaluation in nationwide database data.
Does neoadjuvant chemotherapy improve overall survival, distant relapse-free survival, and local control in patients with synovial sarcoma?
Cohort (n=316)
Yes
Does neoadjuvant chemotherapy improve overall survival, distant relapse-free survival, and local control in patients with synovial sarcoma?
Hazard Ratio: 0.83 (95% CI 0.43–1.57)
Absolute Event Rate: 80.8% vs 81.4%
p-value: p=0.563
In a nationwide retrospective cohort of patients with synovial sarcoma, neoadjuvant chemotherapy did not significantly improve overall survival, local control, or distant relapse-free survival.
No survival benefit with neoadjuvant chemotherapy; leaves open need for randomized trials in synovial sarcoma.
Abstract BackgroundSynovial sarcoma is an aggressive but chemosensitive soft-tissue tumor. We retrospectively analyzed the efficacy of neoadjuvant chemotherapy for synovial sarcoma with data from the nationwide database, Bone and Soft Tissue Tumor Registry in Japan.MethodsThis study included 316 patients diagnosed with synovial sarcoma between 2006 and 2012. Oncologic outcomes were analyzed using a Cox-hazard regression model. The effects of neoadjuvant chemotherapy on outcomes were evaluated using a matched-pair analysis. The oncologic outcomes of patients who did or did not receive neoadjuvant chemotherapy were compared (cx+ and cx-).ResultsMultivariate analysis revealed significant correlations of distant postoperative metastasis (hazard ratio [HR] = 0.01, p<0.001) with overall survival; surgical margin type (marginal resection, HR=0.12, p=0.011 and intralesional resection, HR=0.08, p=0.022 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, neoadjuvant chemotherapy was mainly administered for the patients with younger age, deeper tumor locations, larger tumors, more advanced-stage disease, and monophasic-type disease. The 3-year overall survival rates, local control rates and distant relapse-free survival rates were 82.9% / 80.7% (HR = 0.79, p = 0.102), 91.2% / 89.8% (HR = 1.04, p = 0.837) and 76.6% / 75.0% (HR = 0.76, p = 0.307) in the cx+/cx- groups, respectively. After propensity score matching, 172 patients were selected such that the patient demographics were nearly identical for both the groups. The 3-year overall survival rates, local control rates and distant relapse-free survival rates were 80.8% / 81.4% (HR = 0.83, p = 0.563), 93.2% / 89.4% (HR = 0.83, p = 0.491) and 76.9% / 78.7% (HR = 1.01, p = 0.982) in the cx+ and cx- group, respectively.ConclusionThis 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 neoadjuvant chemotherapy for survival outcomes in synovial sarcoma patients was not proven.
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Xu et al. (2020) conducted a cohort in Synovial sarcoma (n=316). Neoadjuvant chemotherapy vs. No neoadjuvant chemotherapy was evaluated on 3-year overall survival (after propensity score matching) (HR 0.83, 95% CI 0.43-1.57, p=0.563). Neoadjuvant chemotherapy did not significantly improve 3-year overall survival compared to no chemotherapy in a propensity score-matched cohort of patients with synovial sarcoma (HR 0.83, p=0.563).
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