- Efficacy of perioperative chemotherapy for synovial sarcoma: a retrospective analysis of a Nationwide database in Japan. - Background: 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.. - The oncologic outcomes of patients who did or did not receive chemotherapy were compared (cx + and cx-).. - 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.. - The 3-year overall survival, local control, and distant relapse-free survival rates were HR = 0.64, p . - 93.0% (HR = 0.37, p = 0.171) and HR = 0.60, p = 0.089) in the cx+/cx- groups, respectively. - The 3-year overall survival, local control, and distant relapse-free survival rates were HR = 0.48, p HR = 0.51, p = 0.436) and HR = 0.47, p = 0.046) in the cx+/cx- groups, respectively.. - The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. - If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. - To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.. - The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.. - This study was conducted to evaluate the several prog- nostic factors that might affect the oncologic outcomes and to clarify the role of perioperative chemotherapy in the prognosis of SS patients based on a matched-pair analysis (MPA).. - The tumors were located in the lower extremities, upper extremities, trunk, and head/. - Oncologic outcomes Overall survival. - In the univariate ana- lysis, sex, tumor subtype, tumor depth, tumor size, and tumor location had no significant impacts on OS. - Also, the surgical margin type (marginal resection, HR = 0.16, p <. - intralesional resection, HR = 0.29, p = 0.016 versus wide resection) and administration of postoperative radiother- apy (HR = 0.58, p = 0.018) were associated significantly. - The age and surgical margins were retained in the multivariate analysis (Table 1).. - In the univariate analysis, sex, tumor subtype, tumor depth, tumor size, and tumor location had no significant ef- fects on LC. - Moreover, the surgical margin type (mar- ginal resection, HR = 0.12, p = 0.011. - intralesional resection, HR = 0.08, p = 0.022, compared with wide resection) and administration of radiotherapy (HR = 0.24, p = 0.001) were significantly associated with local recurrence. - Surgical margins were retained in the multivariate analysis (Table 1).. - In the univariate analysis, sex, tumor subtype, tumor depth, tumor size, and tumor location had no significant effects on D-RFS.. - 0.56, p = 0.016), postoperative local re- currence (HR = 033, p = 0.004), inadequate surgical margin (marginal resection, HR = 0.21, p <. - 0.01, com- pared with wide resection), and administration of radio- therapy (HR = 0.44, p = 0.02) were identified. - Surgical margins and local recurrence remained significant in the multivariate analysis (Table 1).. - In the cx + group, most patients underwent perioperative chemotherapy with either the adriamycin + ifosfamide (AI) regimen or another doxorubicin regimen, adminis- tered along with cisplatin, ifosfamide, dacarbazine, or vincristine (Table 3). - 3.3%) in the cx + group and in the cx- group (HR p = 0.114), and the 3-year LC rates were in the cx + group and in the cx- group (HR p = 0.171). - The 3-year D-RFS rates were in the cx + group and in the cx- group (HR p = 0.089. - The 3- year OS rates were in the cx + group and in the cx- group (HR . - (±3.7%) in the cx + group and 93.3. - 4.0%) in the cx- group (HR p = 0.436). - The 3- year D-RFS rates were in the cx + group and in the cx- group (HR p = 0.046, Fig. - Analysis of oncologic outcomes of the extracted subgroup consisting of stage III patients. - Before matching, there was no improve- ment in the oncologic outcomes with perioperative chemotherapy. - After matching, 52 cases were almost identical in the two groups. - However, there was still no improvement in the oncologic outcomes (Additional file 2).. - These findings indicated the importance of complete surgical resection to avoid micro/macro-resi- dues of the tumor in the post-resection margins.. - 2 Kaplan-Meier analyses of oncologic outcomes. - The oncologic outcomes of patients who did (cx+) or did not (cx-) receive chemotherapy were compared (red curve: cx + group, black curve: cx- group). - In that study, the 4-year disease-specific survival rates were 88 and 67% in the chemotherapy and no-chemotherapy groups, respect- ively (p = 0.01). - Additionally, treatment with an ifosfamide-based regimen was reported to improve D- RFS (HR = 0.4, p . - 8 cm of grade 2/3, or locally recurrent sarcoma/after in- adequate surgery of grade 2/3) indicated that a regi- men of 3 cycles of neoadjuvant chemotherapy was not superior to surgery alone in the included patients (5- year disease-free survival rates of 56 and 52% for the neoadjuvant chemotherapy and surgery-alone arms, respectively. - Despite propensity matching to reduce intergroup differences, we did not observe significant differences in the onco- logic outcomes of patients in the cx + and cx- groups.. - This result might be criticized because the MPA acted towards reducing high-risk patients in the cx + group (e.g., 117 stage III patients in the cx + group were re- duced to 29 patients after adjustments). - however, we were not able to indicate the superiority of neoadjuvant over adjuvant chemotherapy even in the ex- tracted group consisting of stage III patients. - Recently, a similar methodological study that used the National Cancer Database reported improved OS with chemo- therapy in the MPA of stage III soft tissue sarcoma pa- tients, especially in the undifferentiated pleomorphic sarcoma group [29]. - These trends may be attributed to the fact that Japanese clinicians exclusively administer chemotherapy for com- plicated cases based on their own clinical judgement, which was not quantified in the BSTT database.. - thus, our dataset did not in- clude patients treated at other departments (e.g., retro- peritoneal tumors treated in the urology department).. - BSTT: Bone and Soft Tissue Tumor;. - STS: Soft-tissue sarcomas;. - SS: Synovial sarcoma. - The online version contains supplementary material available at https://doi.. - org/10.1186/s . - Kaplan-Meier analyses of oncologic outcomes (extracted stage III patients). - The oncologic outcomes of patients who did (cx+) or did not (cx-) receive neoadjuvant chemotherapy were compared (red curve: cx + group, black curve: cx- group). - (b) The local control rate of patients with/. - We thank all the hospitals and medical staff who participated in the BSTT Registry, and all the patients whose data were recorded. - HA, conception and design of the study, acquisition, analysis, and interpretation of data, the creation of new software used in the study, drafting the study or substantively revising it. - Consent for publication must be obtained from that person, or in the case of children, their parent or legal guardian.. - https://doi.. - Adjuvant chemotherapy in resectable synovial sarcoma. - https://doi.org/10.1002/jso.24688.. - Influence of neoadjuvant chemotherapy on prognosis of patients with synovial sarcoma. - https://doi.org/10.1186/s . - https://doi.org/10.1093/annonc/. - https://doi.org/10.1002/jso.20974.. - https://doi.org/10.1007/s . - https://doi.org/10.1200/JCO . - https://doi.org/10.1093/a nnonc/mdu362.. - https://doi.org/10.1 002/cncr.24370.. - Effects of adjuvant radiotherapy in patients with synovial sarcoma. - https://doi.org/10.1097/COC . - Management of soft-tissue sarcomas. - https://doi.org/10.1051/sicotj/2017010.. - https://doi.org/1 0.1200/JCO . - https://doi.org/10.1 038/bjc.2015.375.. - Survival in synovial sarcoma. - https://doi.org . - https://doi.org/10.1016/j.jos . - https://doi.org/10.1016/S X.. - Neoadjuvant chemotherapy in soft tissue sarcomas:. - https://doi.org/10.1200/JCO.2017.. - https://doi.org/10.1002/. - https://doi.org/10.1093/annonc/mdu562 Epub 2014 Dec 8. - https://doi.org/10.1016/. - Clinical practice guidelines on the management of soft tissue tumors. - Preoperative and postoperative chemotherapy with ifosfamide and adriamycin for adult high-grade soft-tissue sarcomas in the extremities:. - https://doi.org/10.1093/jjco/hyn153 Epub 2009 Jan 20. - https://doi.org/10.1093/annonc/mdn678.. - Phase II study of neoadjuvant chemotherapy and radiation therapy in the management of high-risk, high- grade, soft tissue sarcomas of the extremities and body wall: radiation therapy oncology group trial 9514. - doi.org/10.1200/JCO PMID: 16446334.. - https://doi.org/10.1002/cncr.32386 Epub 2019 Sep 6. - https://doi.org/10.. - https://doi.org/10.1016/j.ejca Epub 2018 Oct 29. - https://doi.org/10.1002/gcc.22703 PMID: 30387235.
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