{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:43:20Z","timestamp":1784288600173,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T00:00:00Z","timestamp":1726272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Synovial sarcoma is rare and may present as a small, slow-growing mass. These tumors are often mistaken as benign and are therefore prone to unplanned and\/or non-oncologic excision. We sought to identify the rate of unplanned excision of synovial sarcoma and risk factors for recurrence and survival among this cohort. Methods: The medical records of 246 patients evaluated at a single institution for synovial sarcoma between 1997 and 2022 were retrospectively reviewed. Of these, 87 (35%) underwent unplanned, non-oncologic excision. The mean age of the cohort was 49 years. Primary tumors were located in the extremity (n = 63), abdomen (n = 6), thorax (n = 7), head\/neck (n = 8), and paraspinal region (n = 3). The median maximum pre-treatment dimension of the primary tumor was 4.8 cm (IQR 7\u20132.4). Seventy-seven (86%) patients underwent re-excision of the tumor bed, 39 (45%) received chemotherapy, and 63 (72%) received radiation therapy. Results: Among patients who underwent unplanned excision, local recurrence-free survival (LRFS) was 98% at 1 year and 82% at 5 years. Metastasis-free survival (MFS) was 91% at 1 year and 72% at 5 years. Disease-specific survival (DSS) was 98% at 1 year and 72% at 5 years. When adjusting for tumor size, tumors which underwent unplanned excision did not have worse recurrence or survival compared to those which had planned excision (p &gt; 0.10). Size &gt; 5 cm, monophasic subtype, and axial location were associated with increased risk of disease recurrence. Forty-six patients had residual tumor following re-excision, which was associated with worse MFS (HR 8.17, 95% CI [1.89, 35.2], p &lt; 0.01) and DSS (HR 7.66, 95% CI [1.76, 33.4], p &lt; 0.01). Patients who received radiotherapy had improved MFS (HR 6.4, 95% CI [1.42, 29.0], p = 0.02) and DSS (HR 5.86, 95% CI [1.27, 26.9], p = 0.02). Conclusions: One-third of patients presenting with synovial sarcoma were diagnosed after unplanned, non-oncologic excision. Patients with large, axial tumors had worse survival. Approximately half of patients who underwent unplanned excision had no residual tumor after pre-operative radiation. The use of radiation was associated with decreased rates of recurrence and improved disease-specific survival. Our results suggest that margin-negative re-resection and radiotherapy should be considered when feasible following unplanned excision of synovial sarcoma.<\/jats:p>","DOI":"10.3390\/cancers16183157","type":"journal-article","created":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T10:56:57Z","timestamp":1726484217000},"page":"3157","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Unplanned Excision of Synovial Sarcoma: Factors Associated with Recurrence and Survival"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4192-4133","authenticated-orcid":false,"given":"Samuel E.","family":"Broida","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra M.","family":"Arguello","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikaela H.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven I.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-6946","authenticated-orcid":false,"given":"Scott H.","family":"Okuno","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany L.","family":"Siontis","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7659-5766","authenticated-orcid":false,"given":"Thanh P.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8747-692X","authenticated-orcid":false,"given":"Meng","family":"Xu-Welliver","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0390-1018","authenticated-orcid":false,"given":"Matthew T.","family":"Houdek","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Larios, F., Gonzalez, M.R., Ruiz-Arellanos, K., Aquilino, E.S.G., and Pretell-Mazzini, J. (2024). Is Unplanned Excision of Soft Tissue Sarcomas Associated with Worse Oncological Outcomes?-A Systematic Review and Meta-Analysis. Cancers, 16.","DOI":"10.3390\/cancers16020443"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3028","DOI":"10.1007\/s11999-010-1392-7","article-title":"Clinical and treatment outcomes of planned and unplanned excisions of soft tissue sarcomas","volume":"468","author":"Arai","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jor.2021.05.022","article-title":"Re-excision after unplanned excision of soft tissue sarcoma: A systematic review and metanalysis. The rationale of systematic re-excision","volume":"25","author":"Sacchetti","year":"2021","journal-title":"J. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1245\/s10434-016-5462-2","article-title":"Primary Extremity Soft Tissue Sarcomas: Does Local Control Impact Survival?","volume":"24","author":"Bonvalot","year":"2017","journal-title":"Ann. Surg. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1002\/jso.27424","article-title":"Optimal timing of re-excision in synovial sarcoma patients: Immediate intervention versus waiting for local recurrence","volume":"128","author":"Zhang","year":"2023","journal-title":"J. Surg. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3526","DOI":"10.1245\/s10434-019-07494-6","article-title":"Watch and Wait Approach for Re-excision After Unplanned Yet Macroscopically Complete Excision of Extremity and Superficial Truncal Soft Tissue Sarcoma is Safe and Does Not Affect Metastatic Risk or Amputation Rate","volume":"26","author":"Decanter","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1002\/jso.25521","article-title":"The impact of unplanned excisions of truncal\/extremity soft tissue sarcomas: A multi-institutional propensity score analysis from the US Sarcoma Collaborative","volume":"120","author":"Zaidi","year":"2019","journal-title":"J. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/(SICI)1096-9098(199710)66:2<81::AID-JSO2>3.0.CO;2-H","article-title":"The impact of residual disease on local recurrence in patients treated by initial unplanned resection for soft tissue sarcoma of the extremity","volume":"66","author":"Davis","year":"1997","journal-title":"J. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e23437","DOI":"10.1016\/j.heliyon.2023.e23437","article-title":"The efficacy of re-excision after unplanned excision for synovial sarcoma","volume":"10","author":"Yuan","year":"2024","journal-title":"Heliyon"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.3390\/curroncol28030177","article-title":"Synovial Sarcoma: A Clinical Review","volume":"28","author":"Gazendam","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3537","DOI":"10.1002\/cncr.24424","article-title":"Comparing children and adults with synovial sarcoma in the Surveillance, Epidemiology, and End Results program, 1983 to 2005: An analysis of 1268 patients","volume":"115","author":"Sultan","year":"2009","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2309499020936009","DOI":"10.1177\/2309499020936009","article-title":"Epidemiology, incidence, and survival of synovial sarcoma subtypes: SEER database analysis","volume":"28","author":"Aytekin","year":"2020","journal-title":"J. Orthop. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1200\/JCO.2000.18.10.2087","article-title":"Synovial sarcoma: A multivariate analysis of prognostic factors in 112 patients with primary localized tumors of the extremity","volume":"18","author":"Lewis","year":"2000","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1200\/JCO.2001.19.2.525","article-title":"Prognostic factors in localized primary synovial sarcoma: A multicenter study of 128 adult patients","volume":"19","author":"Trassard","year":"2001","journal-title":"J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1245\/s10434-020-08240-z","article-title":"Designing a Rational Follow-Up Schedule for Patients with Extremity Soft Tissue Sarcoma","volume":"27","author":"Wilson","year":"2020","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8704936","DOI":"10.1155\/2019\/8704936","article-title":"A Retrospective Case Series of Synovial Sarcoma of the Upper Extremity","volume":"2019","author":"Post","year":"2019","journal-title":"Sarcoma"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Liang, Y., Guo, T.H., Xu, B.S., Hong, D.C., Qiu, H.B., Zhou, Z.W., and Zhang, X. (2020). The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.617590"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.jss.2020.05.075","article-title":"Radiotherapy is Associated With Improved Survival in Patients With Synovial Sarcoma Undergoing Surgery: A National Cancer Database Analysis","volume":"255","author":"Gingrich","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1002\/jso.23780","article-title":"Perioperative radiotherapy is associated with improved survival among patients with synovial sarcoma: A SEER analysis","volume":"111","author":"Naing","year":"2015","journal-title":"J. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1245\/s10434-017-5776-8","article-title":"The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study","volume":"24","author":"Smolle","year":"2017","journal-title":"Ann. Surg. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3868","DOI":"10.1002\/cncr.31648","article-title":"Influence of unplanned excisions on the outcomes of patients with stage III extremity soft-tissue sarcoma","volume":"124","author":"Traub","year":"2018","journal-title":"Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1002\/cam4.615","article-title":"Outcomes of unplanned sarcoma excision: Impact of residual disease","volume":"5","author":"Charoenlap","year":"2016","journal-title":"Cancer Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Fromm, J., Klein, A., Mentrup, F., Lindner, L.H., Nachbichler, S., Holzapfel, B.M., Goller, S.S., Knosel, T., and Durr, H.R. (2024). Unplanned Resections of Soft Tissue Sarcomas-Necessity of Re-Resection?. Cancers, 16.","DOI":"10.3390\/cancers16101851"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1111\/joim.13717","article-title":"Sarcoma care in the era of precision medicine","volume":"294","author":"Wallander","year":"2023","journal-title":"J. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ho, X.D., Nguyen, H.G., Trinh, L.H., Reimann, E., Prans, E., K\u00f5ks, G., Maasalu, K., Le, V.Q., Nguyen, V.H., and Le, N.T.N. (2017). Analysis of the Expression of Repetitive DNA Elements in Osteosarcoma. Front. Genet., 8.","DOI":"10.3389\/fgene.2017.00193"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/PAI.0000000000001049","article-title":"Expanding the Use of an SS18-SSX Antibody for Molecular Assays in Synovial Sarcoma","volume":"30","author":"Raquib","year":"2022","journal-title":"Appl. Immunohistochem. Mol. Morphol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/18\/3157\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:56:24Z","timestamp":1760111784000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/18\/3157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,14]]},"references-count":26,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["cancers16183157"],"URL":"https:\/\/doi.org\/10.3390\/cancers16183157","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,14]]}}}