The impact of margins and re-resection in pediatric synovial sarcoma

IF 2.9 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2024-09-15 DOI:10.1002/cam4.70207

Andres F. Espinoza, Priya B. Shetty, Jillian C. Jacobson, Hannah Todd, Kelley Harrell, Alfred F. Trappey, John Doski, Eumenia C. Castro, Nicole I. Montgomery, M. Fatih Okcu, Rajkumar Venkatramani, Dai H. Chung, Sanjeev A. Vasudevan

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Abstract

Introduction

Synovial sarcoma is one of the most common soft tissue sarcomas in children. Guidelines regarding the adequate extent of resection margins and the role of re-resection are lacking. We sought to evaluate the adequate resection margin and the role of re-resection in predicting outcomes in children with synovial sarcomas.

Methods

A cohort of 36 patients less than 18 years of age at diagnosis who were treated for localized synovial sarcoma at three tertiary pediatric hospitals between January 2004 and December 2020 were included in this study. Patient and tumor demographics, treatment information, and margin status after surgical resection were collected from the medical record. Clinical, treatment, and surgical characteristics, as well as outcomes including hazard ratios (HRs), event-free survival (EFS), and overall survival (OS) were compared by resection margins group and re-resection status.

Results

Patients in the R1 resection group were significantly more likely to relapse or die compared to patients in the R0 resection group. However, there was no significant difference in EFS (HR 0.52, p = 0.54) or OS (HR 1.56, p = 0.719) in R0 patients with less than 5 mm margins compared to R0 patients with more than 5 mm margins. Patients with R1 on initial or re-resection had significantly worse OS than patients who had R0 resection on initial or re-resection (HR = 10.12, p = 0.005).

Conclusion

This study re-affirms that R0 resection is an independent prognostic predictor of better OS/EFS in pediatric synovial sarcoma. Second, our study extends this finding to report negative margins on initial resection or re-resection is associated with better OS/EFS than positive margins on initial resection or re-resection. Lastly, we found that there is no difference in outcomes associated with re-resection or <5 mm margins for R0 patients, indicating that re-resection and <5 mm margins are acceptable if microscopic disease is removed.

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边缘和再切除对小儿滑膜肉瘤的影响

简介：滑膜肉瘤是儿童最常见的软组织肉瘤之一。目前还缺乏关于切除边缘的适当范围和再次切除的作用的指南。我们试图评估适当的切除边缘和再次切除在预测滑膜肉瘤患儿预后中的作用。方法本研究纳入了 2004 年 1 月至 2020 年 12 月期间在三家三级儿科医院接受局部滑膜肉瘤治疗的 36 例诊断时年龄小于 18 岁的患者。研究人员从病历中收集了患者和肿瘤的人口统计学资料、治疗信息以及手术切除后的边缘状态。按切除边缘组和再次切除状态比较临床、治疗和手术特征，以及包括危险比（HR）、无事件生存期（EFS）和总生存期（OS）在内的结果。结果 R1切除组患者复发或死亡的几率明显高于R0切除组患者。然而，边缘小于5毫米的R0患者与边缘大于5毫米的R0患者在EFS（HR 0.52，p = 0.54）或OS（HR 1.56，p = 0.719）方面没有明显差异。初次或再次切除时为 R1 的患者的 OS 明显差于初次或再次切除时为 R0 的患者（HR = 10.12，P = 0.005）。结论本研究再次证实，R0切除术是预测小儿滑膜肉瘤较佳OS/EFS的独立预后指标。其次，我们的研究扩展了这一发现，报告初次切除或再次切除时边缘阴性比初次切除或再次切除时边缘阳性与更好的 OS/EFS 相关。最后，我们发现对于 R0 患者，再次切除或<5 mm切缘与预后没有差异，这表明如果切除了微小病灶，再次切除和<5 mm切缘是可以接受的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.