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A Mouse Model of Incompletely Resected Soft Tissue Sarcoma for Testing Neoadjuvant Therapies
Published on: July 28, 2020
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Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities
Ugwuji N Maduekwe1,2, Joshua N Herb1,3, Robert J Esther2,4
1Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
Journal of Surgical Oncology
|March 22, 2021
Summary
Synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid (SCARE) sarcomas can involve lymph nodes. Clinically node-negative patients with clear cell and angiosarcoma subtypes benefit from nodal evaluation due to higher positivity rates and survival impact.
Area of Science:
- Oncology
- Surgical Pathology
- Cancer Research
Background:
- Synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid (SCARE) soft tissue sarcomas carry a risk of nodal metastasis.
- Nodal positivity rates and their prognostic significance in clinically node-negative SCARE sarcoma patients remain underexplored.
Purpose of the Study:
- To investigate the rates of nodal involvement and the impact of nodal status on survival in clinically node-negative SCARE sarcoma patients.
- To identify factors associated with regional lymph node surgery (RLNS) and nodal positivity in this cohort.
Main Methods:
- Retrospective analysis of 4158 patients with extremity SCARE sarcoma and no clinical nodal involvement from the National Cancer Database (2004-2017).
- Logistic regression models assessed predictors of RLNS and nodal positivity.
- Kaplan-Meier and Cox regression analyses evaluated the association between nodal status and overall survival.
Main Results:
- 16% of patients underwent RLNS. Epithelioid (OR: 3.77) and clear cell (OR: 6.38) sarcomas were most likely to undergo RLNS.
- Nodal positivity was found in 7% of patients, with clear cell sarcoma (14%) and angiosarcoma (13%) exhibiting the highest rates.
- Positive nodal status significantly reduced 5-year overall survival, particularly in clear cell and angiosarcoma subtypes.
Conclusions:
- A discrepancy exists between patient selection for nodal evaluation and factors predicting nodal positivity.
- Pathologic nodal evaluation should be considered for clinically node-negative patients with clear cell and angiosarcoma, given their elevated risk of nodal metastasis and survival impact.
