Surgical Resection for Pediatric Synovial Sarcoma: What Margin Is Adequate?

Abstract

INTRODUCTION: Synovial sarcoma is the most common nonrhabdomyosarcoma soft tissue sarcoma in children. Guidelines concerning the size of resection margins are lacking. We sought to evaluate if negative microscopic resection margins predicted overall survival. METHODS: A retrospective chart review showed 22 patients with synovial sarcoma from September 2011 to November 2019 at Texas Children’s Hospital. Pearson’s chi-square test and multivariate regression analyses were used. RESULTS: Relapsed free survival was 59% and overall survival was 72% with a median follow-up of 3 years (with interquartile range [IQR] 1.6 to 4.9 years) from initial resection (Figure). The patients with negative margins had a median resection margin of 1.5 mm (IQR 1 to 27mm). Positive microscopic margins were noted in 71% (5/7) of the patients who died compared with 12% (2/16) of patients who survived (p = 0.01). Survival in patients with surgical margins of <5 mm was 100% (7/7) compared with the 28% (2/7) of patients with positive surgical margins (p = 0.02). Positive microscopic margin was an independent risk factor for death (odds ratio 40, 95% CI 1.98 to 807; p = 0.02) when adjusting for adjuvant chemotherapy and radiation.FigureCONCLUSION: This study revealed that a negative microscopic surgical margin in pediatric synovial sarcoma is an independent prognostic predictor of overall survival.