title: Outcome of chemotherapy in advanced synovial sarcoma patients: Review of 15 clinical trials from the European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group; setting a new landmark for studies in this entity.
abstract: BACKGROUND
  Previous studies in metastatic soft tissue sarcomas (STS) showed that synovial sarcomas tend to have better survival rates and a higher chemosensitivity than other STS subtypes. However, data are derived from relatively small subgroups and statistical significance of these observations is lacking. Larger cohorts are necessary to define and confirm the specific characteristics of this subtype.
  
  
  METHODS
  Patient data were retrieved from 15 European Organisation for Research and Treatment of Cancer advanced first-line STS trials. Patient characteristics, survival and treatment response of synovial sarcoma patients were compared to other STS patients. Univariable and multivariable analyses were performed to evaluate prognostic factors.
  
  
  RESULTS
  In total, 3330 advanced STS patients were retrieved, of whom 313 had a synovial sarcoma. Synovial sarcoma patients were significantly younger (median 40 versus 52 years), more often had extremity primary tumours and had a better performance status (PS 0: 50.2 versus 43.4%) compared to other STS patients. Additionally, synovial sarcoma patients had a significantly better response to chemotherapy (responders: 27.8 versus 18.8%) and better survival rates (progression free survival [PFS]: 6.3 versus 3.7 months; Overall survival [OS]: 15.0 versus 11.7 months). Age, PS, and presence of metastatic disease were defined as prognostic factors for PFS and OS in the univariable analysis. The last two factors were confirmed in the multivariable analysis for OS.
  
  
  CONCLUSIONS
  Advanced synovial sarcomas are a distinct subgroup of STS, with a better response to systemic chemotherapy and longer PFS and OS. These results should be taken into account in the design of future synovial sarcoma specific studies.
authors.affiliation: Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Myrella
authors.initials: M
authors.lastname: Vlenterie
authors.affiliation: European Organization for Research and Treatment of Cancer (EORTC) Head Quarters, Brussels, Belgium.
authors.forename: Saskia
authors.initials: S
authors.lastname: Litière
authors.affiliation: European Organization for Research and Treatment of Cancer (EORTC) Head Quarters, Brussels, Belgium.
authors.forename: Elisa
authors.initials: E
authors.lastname: Rizzo
authors.affiliation: European Organization for Research and Treatment of Cancer (EORTC) Head Quarters, Brussels, Belgium.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Marréaud
authors.affiliation: The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Judson
authors.affiliation: Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Gelderblom
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: Axel
authors.initials: A
authors.lastname: Le Cesne
authors.affiliation: Gerhard Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Wardelmann
authors.affiliation: The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Messiou
authors.affiliation: Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gronchi
authors.affiliation: The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK. Electronic address: winette.vandergraaf@icr.ac.uk.
authors.forename: Winette Ta
authors.initials: WT
authors.lastname: van der Graaf
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013584:Sarcoma, Synovial / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Advanced disease; Chemotherapy; Soft tissue sarcoma; Survival; Synovial sarcoma; Treatment response