Abstract
11570 Background: Synovial sarcoma (SS) is a rare, slow growing, and aggressive soft tissue sarcoma that commonly affects young adults, with a diagnosis at an average age of 30 years. It usually originates near the joints of the extremities and presents as a painless lump. Metastasis to the regional lymph nodes and lungs is common. SS is proposed to be a result of a chromosomal translocation leading to the fusion of SYT and SSX genes. Standard treatment is tumor resection followed by adjuvant therapy. No study has compared the effects of different surgery and adjuvant therapy types on overall survival. This study will compare the effects of various therapeutic modalities on overall survival for patients with SS. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with SS from 2004 to 2020 using histology code 9040 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05. Results: The sample retrieved from NCDB consisted of 2566 patients with SS. Of these 2566 patients, 1962 patients (76.5%) received surgery at the primary site. The receipt of surgery was associated with a marked increase in survival (132.2 months vs. 48.6 months, p<0.001). Out of the surgical patients, 883 patients (45.0%) received a lobectomy, 696 patients (35.5%) received a wedge segmental resection, 21 patients (1.07%) received an extended lobectomy and 1 patient (0.05%) received a hepatectomy. Patients who underwent lobectomy and wedge/segmental resections had improved outcomes compared to patients who received other types of surgery (p<0.001). In addition, 898 patients (45.8%) received adjuvant chemotherapy, 38 patients received adjuvant chemoradiation (1.94%), and 22 patients received adjuvant radiation (1.12%). The receipt of adjuvant chemotherapy was associated with better outcomes than receiving no adjuvant therapy (121.9 months vs. 108.4 months, p<0.001). The receipt of adjuvant chemoradiation was also associated with better outcomes than receiving no adjuvant therapy (132.2 months vs. 108.4 months, p=0.023). The receipt of adjuvant chemotherapy versus adjuvant chemoradiation is not significantly different in regard to overall survival. Conclusions: This study confirms that receiving surgery for SS is associated with markedly increased overall survival. Furthermore, wedge/segmental resections and lobectomies are associated with improved outcomes compared to other types of surgery. Receiving adjuvant therapy is associated with improved outcomes as compared to the receipt of surgery alone. Adjuvant chemotherapy and adjuvant chemoradiation are associated with better outcomes than adjuvant radiation alone. Further studies are needed to understand the factors involved in choosing specific treatment modalities for SS.