Long Term Survival of Synovial Sarcoma and Treatment Strategy

Song, Won Seok; Jeon, Dae Geun; Park, Jong Hoon; Cho, Wan Hyeong; Lee, Soo Yong; Oh, Jung Moon; Kim, Jin Wook

Abstract

PURPOSE
The object of the current study was to evaluate the long term survival of synovial sarcoma and to find an appropriate treatment strategy with a favorable prognosis. MATERIALS AND METHODS: Between August 1985 and June 2000, fifty nine synovial sarcoma patients without metastasis at presentation were analyzed and followed for 50.9 (8-161) months. Kaplan-Meier plots were used for survival analysis. Analyzed prognostic factors were sex, age, stage, location, surgical margin, chemotherapy, radiation therapy, local recurrence and metastasis. The log-rank test was used for univariate analysis and the Cox regression model for multivariate analysis. RESULTS: Fourteen-year actual and continuous disease free survivals (ADF/CDF) were 56.4 and 49.7%, respectively. CDF of stage I-IIa and IIb-III were 53.6 and 43.2%, respectively (p=0.55). For local recurrence according to surgical margin, 4 recurrences occurred in 44 wide margins, 1 recurrence in 6 marginal margins, and 1 recurrence in 2 intralesional margins. Among 10 cases of local recurrence, 4 cases had metastasis. Local recurrence, metastasis, and surgical margin had statistical significance in the univariate (p< 0.0001, p<0.0001, p=0.011) and multivariate analysis. CONCLUSION: Fourteen year CDF survival was 49.7%. The alleviation of local recurrence and metastasis is essential for long term survival. In the current study, the only factor under our control was surgical margin. A well designed surgical approach will reduce the recurrence rate.