Prognostic Relevance of Tumor Localization in Patients with Synovial Sarcoma
Received Date : 25 Sep 2023
Accepted Date : 14 Nov 2023
Available Online : 29 Nov 2023
Doi: 10.37047/jos.2023-99660 - Article's Language: EN
Journal of Oncological Sciences. 2024;10(1):17-24.
This is an open access article under the CC BY-NC-ND license
Objective: Synovial sarcoma, an aggressive subtype of soft tissue tumors, mainly occurs in young individuals. In patients with synovial sarcoma, the tumor is predominantly localized in the lower extremities, cases. The present study aimed to investigate the contribution of tumor localization to the prognosis of patients with synovial sarcoma and to determine the factors affecting patient survival. Material and Methods: We retrospectively analyzed the clinical data of 35 patients with synovial sarcoma who were treated at our clinic between February 2000 and October 2022. Overall survival (OS) and the factors affecting patient survival were investigated. Results: The primary site of tumor mass localization was the limb in 19 patients (54.3%) and an extrinsic site in 16 patients (45.7%). The most common extrinsic site of tumor mass localization was the lung in 22.9% patients, followed by intra-abdominal localization in 8.6% patients. Of the 35 patients, 88.6% patients had undergone surgery, and 34.3% patients had received adjuvant chemotherapy, namely the Ifosfamide-Mesna-Doxorubicin regimen. The median OS was 51.1 months. Tumor localization to the limb, presence of curative surgery, and an Eastern Cooperative Oncology Group performance status score of 0-1 were found to be the independent prognostic factors affecting the OS. Conclusion: In the present study, the survival rate of patients with tumor localization in the limb was higher than that of patients with tumor localization at an extrinsic site. Local recurrence and progression rates were lower with curative surgery. The prognosis of patients who could not be treated curatively was poor.
  1. Mastrangelo G, Coindre JM, Ducimetière F, et al. Incidence of soft tissue sarcoma and beyond: a population-based prospective study in 3 European regions. Cancer. 2012;118(21):5339-5348. [Crossref]  [PubMed] 
  2. Gazendam AM, Popovic S, Munir S, Parasu N, Wilson D, Ghert M. Synovial sarcoma: a clinical review. Curr Oncol. 2021;28(3):1909-1920. [Crossref]  [PubMed]  [PMC] 
  3. Aytekin MN, Öztürk R, Amer K, Yapar A. Epidemiology, incidence, and survival of synovial sarcoma subtypes: SEER database analysis. J Orthop Surg (Hong Kong). 2020;28(2):2309499020936009. [Crossref]  [PubMed] 
  4. Sultan I, Rodriguez-Galindo C, Saab R, Yasir S, Casanova M, Ferrari A. Comparing children and adults with synovial sarcoma in the Surveillance, Epidemiology, and End Results program, 1983 to 2005: an analysis of 1268 patients. Cancer. 2009;115(15):3537-3547. [Crossref]  [PubMed] 
  5. De Silva MV, Barrett A, Reid R. Premonitory pain preceding swelling: a distinctive clinical presentation of synovial sarcoma which may prompt early detection. Sarcoma. 2003;7(3-4):131-135. [Crossref]  [PubMed]  [PMC] 
  6. Guadagnolo BA, Zagars GK, Ballo MT, et al. Long-term outcomes for synovial sarcoma treated with conservation surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2007;69(4):1173-1180. [Crossref]  [PubMed] 
  7. Frustaci S, Gherlinzoni F, De Paoli A, et al. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian randomized cooperative trial. J Clin Oncol. 2001;19(5):1238-1247. [Crossref]  [PubMed] 
  8. Desar IME, Fleuren EDG, van der Graaf WTA. Systemic treatment for adults with synovial sarcoma. Curr Treat Options Oncol. 2018;19(2):13. [Crossref]  [PubMed]  [PMC] 
  9. Constantinidou A, van der Graaf WTA. The fate of new fosfamides in phase III studies in advanced soft tissue sarcoma. Eur J Cancer. 2017;84:257-261. [Crossref]  [PubMed] 
  10. Seddon B, Strauss SJ, Whelan J, et al. Gemcitabine and docetaxel versus doxorubicin as first-line treatment in previously untreated advanced unresectable or metastatic soft-tissue sarcomas (GeDDiS): a randomised controlled phase 3 trial. Lancet Oncol. 2017;18(10):1397-1410. [Crossref]  [PubMed]  [PMC] 
  11. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99. [Crossref]  [PubMed] 
  12. Vlenterie M, Ho VK, Kaal SE, Vlenterie R, Haas R, van der Graaf WT. Age as an independent prognostic factor for survival of localised synovial sarcoma patients. Br J Cancer. 2015;113(11):1602-1606. [Crossref]  [PubMed]  [PMC] 
  13. Ferrari A, Gronchi A, Casanova M, et al. Synovial sarcoma: a retrospective analysis of 271 patients of all ages treated at a single institution. Cancer. 2004;101(3):627-634. [Crossref]  [PubMed] 
  14. Spillane AJ, A'Hern R, Judson IR, Fisher C, Thomas JM. Synovial sarcoma: a clinicopathologic, staging, and prognostic assessment. J Clin Oncol. 2000;18(22):3794-3803. [Crossref]  [PubMed] 
  15. Trassard M, Le Doussal V, Hacène K, et al. Prognostic factors in localized primary synovial sarcoma: a multicenter study of 128 adult patients. J Clin Oncol. 2001;19(2):525-534. [Crossref]  [PubMed] 
  16. Singer S, Baldini EH, Demetri GD, Fletcher JA, Corson JM. Synovial sarcoma: prognostic significance of tumor size, margin of resection, and mitotic activity for survival. J Clin Oncol. 1996;14(4):1201-1208. [Crossref]  [PubMed] 
  17. Lewis JJ, Antonescu CR, Leung DH, et al. Synovial sarcoma: a multivariate analysis of prognostic factors in 112 patients with primary localized tumors of the extremity. J Clin Oncol. 2000;18(10):2087-2094. [Crossref]  [PubMed] 
  18. Gundle KR, Kafchinski L, Gupta S, et al. Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. J Clin Oncol. 2018;36(7):704-709. [Crossref]  [PubMed] 
  19. Biau DJ, Ferguson PC, Chung P, et al. Local recurrence of localized soft tissue sarcoma: a new look at old predictors. Cancer. 2012;118(23):5867-5877. [Crossref]  [PubMed] 
  20. Grobmyer SR, Maki RG, Demetri GD, et al. Neo-adjuvant chemotherapy for primary high-grade extremity soft tissue sarcoma. Ann Oncol. 2004;15(11):1667-1672. [Crossref]  [PubMed] 
  21. Blay JY, von Mehren M, Jones RL, et al. Synovial sarcoma: characteristics, challenges, and evolving therapeutic strategies. ESMO Open. 2023;8(5):101618. [Crossref]  [PubMed]  [PMC] 
  22. Tansir G, Rastogi S, Kumar A, et al. A phase II study of gemcitabine and docetaxel combination in relapsed metastatic or unresectable locally advanced synovial sarcoma. BMC Cancer. 2023;23(1):639. [Crossref]  [PubMed]  [PMC]