Riad and colleagues studied how often extremity soft‑tissue sarcoma spreads to lymph nodes, which tumors do so, and how nodal spread and its treatment affect survival.
Retrospective review of a prospective Toronto database of 1066 patients operated on for extremity soft‑tissue sarcoma, 1986 to 2001, of whom 39 developed nodal metastases.
Key Findings
Nodal metastases developed in 39 of 1066 patients (3.7%). Rates were highest in epithelioid sarcoma (3 of 15), rhabdomyosarcoma (4 of 21), clear cell sarcoma (2 of 18) and angiosarcoma (2 of 18).
Only grade predicted nodal spread: 1 of 201 grade 1, 5 of 327 grade 2 and 33 of 538 grade 3 tumors. Location, size and depth carried no added risk.
After node resection, estimated 5‑year survival was 57% (n = 30). All 9 treated palliatively died within 30 months, but they were more likely to be older, with extensive, unresectable or systemic disease.
Estimated 4‑year survival was 71% with isolated nodal metastases vs 21% with nodal plus systemic disease. Isolated nodes at diagnosis and later isolated nodes did not differ significantly.
Survival with isolated nodal disease did not differ from 470 Stage III sarcomas (p = 0.93), though the nodal group was timed from nodal diagnosis and Stage III from sarcoma diagnosis.
Regional disease recurred in 3 of 30 after node resection. Adjuvant radiation and chemotherapy were individualized, not randomized, and chemotherapy use changed during the study.
Board pearl
Resected isolated sarcoma nodal metastases were not uniformly fatal. The AJCC 6th edition used here put nodal and distant metastases together in Stage IV, and the authors suggest separating isolated nodal disease.
Authors' conclusion
These results suggest that long-term survival is possible after surgical resection of lymphatic metastases from soft tissue sarcoma. The American Joint Committee on Cancer should consider separating isolated nodal metastases from systemic involvement in patients with Stage IV sarcoma.
Riad and colleagues studied how often extremity soft‑tissue sarcoma spreads to lymph nodes, which tumors do so, and how nodal spread and its treatment affect survival.
Retrospective review of a prospective Toronto database of 1066 patients operated on for extremity soft‑tissue sarcoma, 1986 to 2001, of whom 39 developed nodal metastases.
Key Findings
Nodal metastases developed in 39 of 1066 patients (3.7%). Rates were highest in epithelioid sarcoma (3 of 15), rhabdomyosarcoma (4 of 21), clear cell sarcoma (2 of 18) and angiosarcoma (2 of 18).
Only grade predicted nodal spread: 1 of 201 grade 1, 5 of 327 grade 2 and 33 of 538 grade 3 tumors. Location, size and depth carried no added risk.
After node resection, estimated 5‑year survival was 57% (n = 30). All 9 treated palliatively died within 30 months, but they were more likely to be older, with extensive, unresectable or systemic disease.
Estimated 4‑year survival was 71% with isolated nodal metastases vs 21% with nodal plus systemic disease. Isolated nodes at diagnosis and later isolated nodes did not differ significantly.
Survival with isolated nodal disease did not differ from 470 Stage III sarcomas (p = 0.93), though the nodal group was timed from nodal diagnosis and Stage III from sarcoma diagnosis.
Regional disease recurred in 3 of 30 after node resection. Adjuvant radiation and chemotherapy were individualized, not randomized, and chemotherapy use changed during the study.
Board pearl
Resected isolated sarcoma nodal metastases were not uniformly fatal. The AJCC 6th edition used here put nodal and distant metastases together in Stage IV, and the authors suggest separating isolated nodal disease.
Authors' conclusion
These results suggest that long-term survival is possible after surgical resection of lymphatic metastases from soft tissue sarcoma. The American Joint Committee on Cancer should consider separating isolated nodal metastases from systemic involvement in patients with Stage IV sarcoma.