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.
References
Keung EZ, Chiang YJ, Voss RK, et al. Defining the incidence and clinical significance of lymph node metastasis in soft tissue sarcoma. Eur J Surg Oncol. 2018;44:170–7. https://doi.org/10.1016/j.ejso.2017.11.014.
Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg. 1993;217(1):72–7. https://doi.org/10.1097/00000658-199301000-00012.
Witt RG, Cope B, Erstad DJ, et al. Sentinel lymph node biopsy and formal lymphadenectomy for soft tissue sarcoma: a single-center experience of 86 consecutive cases. Ann Surg Oncol. 2022. https://doi.org/10.1245/s10434-022-11803-x.
Al-Refaie WB, Andtbacka RH, Ensor J, et al. Lymphadenectomy for isolated lymph node metastasis from extremity soft tissue sarcomas. Cancer. 2008;112:1821–6. https://doi.org/10.1002/cncr.23363.
Basile G, Mattei JC, Alshaygy I, et al. Curability of patients with lymph node metastases from extremity soft tissue sarcoma. Cancer. 2020;126:5098–108. https://doi.org/10.1002/cncr.33189.
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Christina Roland received research funding from Bristol Myers Squibb. The remaining authors have no conflicts of interest.
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Witt, R.G., Roland, C.L. & Keung, E.Z. ASO Author Reflections: Lymph Node Disease in Soft Tissue Sarcoma: A Problematic Clinical Dilemma. Ann Surg Oncol 29, 7101 (2022). https://doi.org/10.1245/s10434-022-11825-5
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DOI: https://doi.org/10.1245/s10434-022-11825-5