Premium
Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities
Author(s) -
Maduekwe Ugwuji N.,
Herb Joshua N.,
Esther Robert J.,
Kim Hong Jin,
Spanheimer Philip M.
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26465
Subject(s) - medicine , nodal , soft tissue sarcoma , angiosarcoma , clear cell sarcoma , sarcoma , lymph node , odds ratio , radiology , proportional hazards model , rhabdomyosarcoma , surgery , soft tissue , pathology
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.