Evaluation of conditional treatment effects of adjuvant treatments on patients with synovial sarcoma using Bayesian subg
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Evaluation of conditional treatment effects of adjuvant treatments on patients with synovial sarcoma using Bayesian subgroup analysis Sung Wook Seo1* , Jisoo Kim1, Jihye Son1 and Sungbin Lim2
Abstract Background: The impact of adjuvant chemotherapy or radiation therapy on the survival of patients with synovial sarcoma (SS), which is a rare soft-tissue sarcoma, remains controversial. Bayesian statistical approaches and propensity score matching can be employed to infer treatment effects using observational data. Thus, this study aimed to identify the individual treatment effects of adjuvant therapies on the overall survival of SS patients and recognize subgroups of patients who can benefit from specific treatments using Bayesian subgroup analyses. Methods: We analyzed data from patients with SS obtained from the surveillance, epidemiology, and end results (SEER) public database. These data were collected between 1984 and 2014. The treatment effects of chemotherapy and radiation therapy on overall survival were evaluated using propensity score matching. Subgroups that could benefit from radiation therapy or chemotherapy were identified using Bayesian subgroup analyses. Results: Based on a stratified Kaplan–Meier curve, chemotherapy exhibited a positive average causal effect on survival in patients with SS, whereas radiation therapy did not. The optimal subgroup for chemotherapy includes the following covariates: older than 20 years, male, large tumor (longest diameter > 5 cm), advanced stage (SEER 3), extremity location, and spindle cell type. The optimal subgroup for radiation therapy includes the following covariates: older than 20 years, male, large tumor (longest diameter > 5 cm), early stage (SEER 1), extremity location, and biphasic type. Conclusion: In this study, we identified high-risk patients whose variables include age (age > 20 years), gender, tumor size, tumor location, and poor prognosis without adjuvant treatment. Radiation therapy should be considered in the early stages for high-risk patients with biphasic types. Conversely, chemotherapy should be considered for latestage high-risk SS patients with spindle cell types. Keywords: Synovial sarcoma, Bayesian subgroup analysis, Radiation therapy, Chemotherapy Background Synovial sarcoma (SS) is a rare soft-tissue sarcoma that accounts for 6% of all soft-tissue sarcomas [1–3]. Its clinical presentations, including tumor size, location, and *Correspondence: [email protected] 1 Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Full list of author information is available at the end of the article
histological subtype, are diverse and significantly affect prognoses [4]. Because SS is considered as a high-grade sarcoma with poor prognosis, the role of multimodal treatment in patients with SS is heavily debated [1–4]. The effects of adjuvant chemotherapy or radiation therapy (RT) on survival in patients with SS remain controversial because definitive eviden
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