Adjuvant chemotherapy in resectable synovial sarcoma

The role of adjuvant chemotherapy (AC) for synovial sarcoma (SS) is controversial. Using a large national dataset we evaluate the impact of AC on overall survival (OS) following curative-intent resection of SS.

Patients with stage I-III SS 2004-2012 undergoing resection were identified in the National Cancer Data Base. Clinicopathologic factors associated with OS were identified using Cox proportional-hazard modeling, adjusting for factors associated with receipt of AC.

Among 544 patients, 131 received AC. Median age of the cohort was 42 years; 269 were female. AC was not associated with OS in univariate analysis in the overall cohort. After stratification by stage, AC was associated with prolonged OS in univariate analysis in stage III patients only (P = 0.028), which remained significant in multivariable analysis (P = 0.033). Other factors associated with OS in stage III patients were age >55 years, (P = 0.001), positive margins (P = 0.037), biphasic histology (P = 0.013), and adjuvant radiation (P < 0.001). The association between AC and OS remained significant after adjustment for factors predictive of receipt of AC.

In this national cohort, AC was associated with prolonged OS for SS for stage III patients but not in lower stages. Less restricted use of this therapy may be warranted in this population.