Past

Regional lymph node metastasis in patients with soft tissue sarcoma (STS) is an uncommon but consequential event with considerable implications for patient prognosis and oncologic outcomes.1,2 However, the overall impact of regional disease in STS on survival is unclear, as is the appropriate management of isolated lymph node disease.

Present

The current study examined our institutional experience with sentinel lymph node biopsy (SLNB) and formal lymphadenectomy for patients with regional lymph node disease from STS,3 building upon our previously published institutional experience.4 We evaluated 86 total patients who underwent lymph node procedures for STS (SLNB for 34 patients and formal lymphadenectomy for 60 patients). The study found that the patients with a positive SLNB, although few, had overall survival similar to that for those with a negative SLNB. Formal lymphadenectomy for the patients with regional-only disease was associated with a median recurrence-free survival of 44 months and an overall survival of months. Our findings are consistent with those of other recent reports showing that STS patients with regional disease are clinically distinct from those with distant metastatic disease and have superior survival.1,5

Future

Although this study adds to the growing body of literature examining the impact of regional disease in STS and the role of surgical treatment for this entity, considerable work remains ahead to improve understanding of the underlying biology, oncologic significance, and optimal management of STS lymph node metastases. One important step forward involves delineating current practice patterns and attitudes toward the management of regional disease in STS to find better ways of studying this clinical problem, standardizing management, and improving patient outcomes.