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Lymphadenectomy for isolated lymph node metastasis from extremity soft‐tissue sarcomas
Author(s) -
AlRefaie Waddah B.,
Andtbacka Robert H.I.,
Ensor Joe,
Pisters Peter W.T.,
Ellis Tammy L.,
Shrout Anita,
Hunt Kelly K.,
Cormier Janice N.,
Pollock Raphael E.,
Feig Barry W.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23363
Subject(s) - medicine , lymphadenectomy , metastasis , dissection (medical) , stage (stratigraphy) , lymph node , survival rate , cancer , epithelioid sarcoma , oncology , radiology , surgery , soft tissue , biology , paleontology
BACKGROUND Previous studies have suggested that the prognosis in patients with extremity soft‐tissue sarcomas (ESTS) with isolated lymph node (LN) metastases (stage IV) is comparable to that of patients with high‐risk ESTS without metastases (stage III). This study was performed to determine the outcomes of patients who underwent aggressive therapy, including lymphadenectomy in patients with LN metastasis from ESTS. METHODS Demographic details, pathology of the primary disease, timing of LN metastasis, and details of the multimodality treatment were obtained from the medical records of 35 patients with nodal metastasis from ESTS who were treated between 1981 and 2003. Survival after the diagnosis of primary disease and LN metastasis was compared with established historical outcomes for patients with American Joint Commission on Cancer (AJCC) stages III and IV ESTS. RESULTS Epithelioid sarcomas (23%) and malignant fibrous histiocytomas (23%) were the most common primary histologic types. Twenty (57%) patients presented with synchronous nodal metastasis. Median follow‐up from the time of diagnosis of lymph node metastasis was 48.5 months. The 1‐year, 2‐year, and5‐year actuarial survival rates in patients with synchronous nodal metastasis after lymphadenectomy and additional therapy were 79%, 62%, and 52%, respectively. In comparison, the 1‐year, 2‐year, and 5‐year actuarial survival rates in patients with metachronous nodal metastasis after lymphadenectomy and additional therapy were 100%, 95%, and 66%, respectively. CONCLUSIONS Patients with isolated regional lymph node metastases who are treated with aggressive approaches, including regional LN dissection, may experience prolonged survival similar to that which more closely approximates the survival seen in patients with stage III disease (5‐year survival rate, 50%) rather than the survival seen in patients with stage IV disease (5‐year survival rate, 25%). These data lend support for reconsideration of the current AJCC staging system for ESTS. Cancer 2008. © 2008 American Cancer Society.