Clinical outcomes associated with re-excision after unplanned excision or re-excision after local recurrence in patients with nonmetastatic synovial sarcoma

Abstract

Abstract Background: The unplanned excision of synovial sarcomas in centers that do not specialize in sarcoma treatment necessitates extensive wide re-excision to maintain adequate margins. The present study was developed to examine the efficacy in SS patients with and without residual tumor tissue following unplanned surgical excision, and to compare differences in prognostic outcomes between individuals with residual tumor tissue and those that experienced local recurrence. Method: Synovial sarcoma patients that underwent re-excision in our center between 2009 and 2019 were included in unplanned excision and local recurrence groups, with patients in the unplanned excision group being further stratified into those with and without residual tumor tissue. Analyzed endpoints included overall survival (OS), local recurrence-free survival (LRFS), and distant relapse-free survival (DRFS). Prognostic factors associated with these three different survival outcomes were analyzed through the use of Kaplan-Meier curves and Cox regression approaches. Result: In total, this study incorporated 121 synovial sarcoma patients (68 female, 53 male; median age: 36 years), including 33 (27.3%) with no residual tumor tissue, 31 (25.6%) with residual tumor tissue, and 57 (47.1%) in the local recurrence group. Patients were assessed over a median 51-month follow-up period. The respective median intervals to definitive surgery in the unplanned excision and local recurrence groups were 35 days and 60 days. The respective 5-year OS, 5-year LRFS, and 5-year DRFS were 76.9%, 80.6%, and 59.6% for the non-residual group, 73.0%, 80.4%, and Not Available (NA) for the residual tumor tissue group, and 75.2%, 77.3%, and NA in the local recurrence group. Conclusion: In synovial sarcoma patients with positive margins or residual tumor tissue following unplanned surgical excision, re-excision procedures can yield improved local control and OS to levels similar to those observed in patients without residual tumor. Relative to patients with local recurrence, significantly improved local control and OS are observed for patients with residual tumor following immediate extensive R0 resection. These results thus suggest that following initial incomplete tumor excision, patients should be promptly transferred to centers specializing in the treatment of sarcomas for adequate re-excision.