Multimodal Risk-Adapted Treatment in Surgical Patients With Synovial Sarcoma: A Preoperative Nomogram-Guided Adjuvant Treatment Strategy

Abstract

Background: Synovial sarcoma is characterized by heterogeneous clinical manifestations, making it difficult to evaluate individual patients' prognoses and design personal treatment schemes. We established an effective preoperative nomogram to predict cancer-specific survival (CSS) and present a risk-adapted adjuvant treatment strategy in surgical patients with synovial sarcoma.Methods: This retrospective study included patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with synovial sarcoma between 1996 and 2015. The patients were randomly divided into training and validation groups. The predictors were selected using univariate and multivariate Cox hazards models. The nomogram performance was verified for its discriminatory ability and calibration. We further stratified the patients into different risk groups according to the nomogram scores and compared the efficacy of chemotherapy, radiotherapy, and combination of radiotherapy and chemotherapy.Results: There were 915 patients enrolled in our study, with 874 patients either alive or dead due to synovial sarcoma. We established a nomogram to predict 5-year CSS based on independent factors, including sex, age, grade, tumor size, location, and extent (all p < 0.05). Our model showed a consistently good discriminatory ability and calibration for predicting 5-year CSS in both the training (c-index = 0.78, 95% CI 0.75–0.81) and validation (c-index = 0.73, 95% CI 0.68–0.78). Based on their nomogram scores, we divided patients into 5 groups. Compared to patients without adjuvant treatment, nomogram I patients with adjuvant treatment had no improvements in 5-year CSS (100.0% vs. 100.0%), nomogram II patients had higher 5-year CSS with radiotherapy or chemotherapy (92.9% vs. 72.2%, p = 0.015), nomogram III patients had higher 5-year CSS with combination of chemotherapy and radiotherapy (70.1% vs. 47.2%, p = 0.004), nomogram IV patients had higher 5-year CSS with radiotherapy (41.3% vs. 15.6%, p = 0.015), and nomogram V patients had no improvements in 5-year CSS rates with adjuvant treatment (28.9% vs. 16.9%, p = 0.18).Conclusion: The nomogram showed a satisfactory discriminatory ability and calibration for predicting 5-year CSS in synovial sarcoma patients. Based on this nomogram, we stratified synovial sarcoma patients according to risk levels, which enabled us to provide a useful grouping scheme that can inform multimodal risk-adapted treatment in synovial sarcoma.

Nomogram to Predict Overall and Cancer-Specific Survival in Patients with Synovial Sarcoma in the Extremities: A Population-Based Study

“…e higher the age, the worse the prognosis [18,19]. Zeng et al found that sex is also an important factor affecting patient prognosis; while the incidence of men and women is similar, men have worse prognoses [20], which is consistent with our findings. e biphasic subtype showed the best survival rate, and the epithelioid cell subtype had the lowest survival rate, which is in agreement with Xiong et al [11].…”

“…e biphasic subtype showed the best survival rate, and the epithelioid cell subtype had the lowest survival rate, which is in agreement with Xiong et al [11]. Additionally, the larger the tumor, the worse the prognosis [20]. Currently, individualized treatments, including surgery, radiotherapy, chemotherapy, molecular targeted therapy, and cellular immunotherapy, can achieve certain curative effects, but surgery plus appropriate radiotherapy has always been the gold standard [21].…”

Nomograms predicting local and distant recurrence and disease-specific mortality for R0/R1 soft tissue sarcomas of the extremities

“…developed the first nomogram predicting SSS for patients with STS ( 32 ). This model was subsequently externally validated ( 33 ) and followed by many studies developing STS-specific models predicting SSS ( 12 , 14 – 16 , 19 , 22 ) ( Table 4 ). Whereas the model by Kattan et al.…”

“…Recently, several nomograms have been developed for predicting long-term outcomes (relapse, overall, and sarcomaspecific survival) in patients with STS (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Many of them focused on specific sites (i.e., primary STS of the trunk and extremity) (14,18,19) and/or on specific histological subtypes (14-16, 19, 20).…”

“…Recently, several nomograms have been developed for predicting long-term outcomes (relapse, overall, and sarcoma-specific survival) in patients with STS ( 11 – 23 ). Many of them focused on specific sites (i.e., primary STS of the trunk and extremity) ( 14 , 18 , 19 ) and/or on specific histological subtypes ( 14 – 16 , 19 , 20 ). However, with the exception of age, histology, grading, and size, each nomogram identified further different predictors.…”