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Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities. J Surg Oncol 2021 May;123(8):1792-1800

Date

03/23/2021

Pubmed ID

33751586

DOI

10.1002/jso.26465

Scopus ID

2-s2.0-85102814168 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

BACKGROUND AND OBJECTIVES: Synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid (SCARE) soft tissue sarcoma are at risk for nodal involvement, although the nodal positivity rates and impact on prognostication in clinically node negative patients are not well described.

METHODS: Patients with extremity SCARE sarcoma without clinical nodal involvement undergoing surgical resection in the National Cancer Database (2004-2017) were included. Logistic regression was used to evaluate the likelihood of nodal surgery and nodal positivity. Kaplan-Meier method and Cox regression were used to assess associations of nodal status to overall survival.

RESULTS: We included 4158 patients, and 669 patients (16%) underwent regional lymph node surgery (RLNS). On multivariable logistic analysis, patients with epithelioid (odds ratio [OR]: 3.77; p < .001) and clear cell (OR: 6.38; p < .001) were most likely to undergo RLNS. Forty-five patients (7%) had positive nodes. Clear cell sarcoma (14%) and angiosarcoma (13%) had the highest rates of nodal positivity. Patients with positive nodes had reduced 5-year overall survival, and the stratification was largest in clear cell and angiosarcoma.

CONCLUSION: Discordance exists between selection for pathologic nodal evaluation and factors associated with nodal positivity. Clinically node negative patients with clear cell and angiosarcoma should be considered for pathologic nodal evaluation.

Author List

Maduekwe UN, Herb JN, Esther RJ, Kim HJ, Spanheimer PM

Author

Ugwuji N. Maduekwe MD Associate Dean, Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Databases, Factual
Extremities
Humans
Middle Aged
Neoplasm Staging
Retrospective Studies
Sarcoma
Soft Tissue Neoplasms
Survival Rate
Young Adult