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. 2021 May;123(8):1792-1800.
doi: 10.1002/jso.26465. Epub 2021 Mar 22.

Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities

Ugwuji N Maduekwe  1   2 , Joshua N Herb  1   3 , Robert J Esther  2   4 , Hong Jin Kim  1   2 , Philip M Spanheimer  1   2
Affiliations

Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities

Ugwuji N Maduekwe et al. J Surg Oncol. 2021 May.

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.

Keywords: SLNB; angiosarcoma; clear cell sarcoma; epithelioid sarcoma; rhabdomyosarcoma; synovial sarcoma.

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Figures

Figure 1:
Figure 1:
Model results for logistic regression of A) factors associated with receipt of regional lymph node surgery and B) adjusted probabilities of lymph node surgery by sarcoma histology.
Figure 2:
Figure 2:
Model results for logistic regression of factors associated with nodal positivity among those who A) underwent regional lymph node evaluation and B) adjusted probabilities of regional lymph node disease by sarcoma histology.
Figure 3:
Figure 3:
Kaplan-Meier survival curves evaluating overall survival for patients with negative regional lymph nodes, positive regional lymph nodes, and no regional node evaluation by sarcoma histology. Abbreviations: RLNS: regional lymph node surgery; SCARE: Synovial, Clear cell, Angiosarcoma, Rhabdomyosarcoma, Epithelioid.
See this image and copyright information in PMC

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