The impact of margins and re‐resection in pediatric synovial sarcoma
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 ou...
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| Format: | Article |
| Language: | English |
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Wiley
2024-09-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.70207 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Andres F. Espinoza |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-4440fe2c5f774f55b626228e751e301e |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-4440fe2c5f774f55b626228e751e301e2025-02-07T09:08:08ZengWileyCancer Medicine2045-76342024-09-011317n/an/a10.1002/cam4.70207The impact of margins and re‐resection in pediatric synovial sarcomaAndres F. Espinoza0Priya B. Shetty1Jillian C. Jacobson2Hannah Todd3Kelley Harrell4Alfred F. Trappey5John Doski6Eumenia C. Castro7Nicole I. Montgomery8M. Fatih Okcu9Rajkumar Venkatramani10Dai H. Chung11Sanjeev A. Vasudevan12Texas Children's Surgical Oncology Program and Liver Tumor Program, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Dan L. Duncan Cancer Center Baylor College of Medicine Houston Texas USADepartment of Pediatric Hematology and Oncology Baylor College of Medicine and Texas Children's Hospital Houston Texas USADivision of Pediatric Surgery University of Texas Southwestern Medical Center and Children's Health Dallas Texas USATexas Children's Surgical Oncology Program and Liver Tumor Program, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Dan L. Duncan Cancer Center Baylor College of Medicine Houston Texas USADivision of Pediatric Surgery University of Texas San Antonio San Antonio Texas USADivision of Pediatric Surgery University of Texas San Antonio San Antonio Texas USADivision of Pediatric Surgery University of Texas San Antonio San Antonio Texas USADepartment of Pathology and Immunology Baylor College of Medicine and Texas Children's Hospital Houston Texas USADepartment of Orthopedics Baylor College of Medicine, Texas Children's Hospital and Cancer Center Houston Texas USADepartment of Pediatric Hematology and Oncology Baylor College of Medicine and Texas Children's Hospital Houston Texas USADepartment of Pediatric Hematology and Oncology Baylor College of Medicine and Texas Children's Hospital Houston Texas USADivision of Pediatric Surgery University of Texas Southwestern Medical Center and Children's Health Dallas Texas USATexas Children's Surgical Oncology Program and Liver Tumor Program, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Dan L. Duncan Cancer Center Baylor College of Medicine Houston Texas USAAbstract 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.https://doi.org/10.1002/cam4.70207marginspediatricre‐resectionsynovial sarcoma |
| spellingShingle | 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 The impact of margins and re‐resection in pediatric synovial sarcoma Cancer Medicine margins pediatric re‐resection synovial sarcoma |
| title | The impact of margins and re‐resection in pediatric synovial sarcoma |
| title_full | The impact of margins and re‐resection in pediatric synovial sarcoma |
| title_fullStr | The impact of margins and re‐resection in pediatric synovial sarcoma |
| title_full_unstemmed | The impact of margins and re‐resection in pediatric synovial sarcoma |
| title_short | The impact of margins and re‐resection in pediatric synovial sarcoma |
| title_sort | impact of margins and re resection in pediatric synovial sarcoma |
| topic | margins pediatric re‐resection synovial sarcoma |
| url | https://doi.org/10.1002/cam4.70207 |
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