Lymph Node Metastasis From Soft Tissue Sarcoma in Adults Analysis of Data From a Prospective Database of 1772 Sarcoma Patients

Abstract

To examine the natural history of lymph node metastasis from sarcomas and the utility of therapeutic lymphadenectomy, clinical histories of all adult patients identified by a prospective sarcoma database for the 10-year period July 1982 to July 1991 were examined. Of the 1772 sarcoma patients, 46 (2.6%) were identified with lymph node metastasis. Median follow-up of all patients from diagnosis of lymph node metastasis was 12.9 months (range, 0 to 100 months). Median survival for nonsurvivors was 12.7 months (range, 0 to 40.7). The tumor types with the highest incidence of lymph node metastasis are angiosarcoma (5/37 total cases; 13.5%), embryonal rhabdomyosarcoma (ERMS) (12/88 total cases; 13.6%), and epithelioid sarcoma (2/12 total cases; 16.7%). Lymph node metastasis from visceral primary (p = 0.004) and malignant fibrous histiocytomas (p = 0.006) were associated with particularly poor prognosis. Thirty-one patients underwent radical, therapeutic lymphadenectomy with curative intent, whereas 15 patients had less than curative procedures, in most cases biopsy only. Patients not treated with radical lymphadenectomy had a median survival of 4.3 months (range, 1 to 32) whereas radical lymphadenectomy was associated with a 16.3 month median survival and the only long-term survivors (46% 5-year survival by Kaplan-Meier). The authors conclude that lymph node metastases from sarcoma are rare in adults, but vigilance is warranted, especially in angiosarcoma, ERMS, and epithelioid subtypes. Radical lymphadenectomy is appropriate treatment for isolated metastasis to regional lymph nodes and may provide long-term survival.

Soft tissue sarcoma presenting with metastatic disease

“…Other studies have reported 5-year survival rates after aggressive management of isolated lymph node metastases between 34% and 60%. 9,10 This finding of a superior prognosis for patients who present with lymph node metastases in our study and others supports the separation of lymph node metastases and pulmonary metastases in future staging systems for STS.…”

Prognostic Factors for Survival in Patients with Epithelioid Sarcoma: 441 Cases from the SEER Database

“…Nodal involvement is a feature of ES that distinguishes it from most other types of soft tissue sarcomas. Lymph node metastasis occurs in 2.6% of patients with the majority of soft tissue sarcomas [14]. In contrast, lymphatic spread has been reported in 22% to 48% of patients with ES, leading some clinicians to recommend sentinel node biopsy for all patients [23,44].…”

Soft Tissue Sarcomas

“…Lymph node metastasis is rare (less than 5%), except for a few histologic subtypes such as epithelioid sarcoma, synovial sarcoma, rhabdomyosarcoma, clear-cell sarcoma, and angiosarcoma. 4 External radiation therapy is a well-established risk factor for soft tissue sarcoma, as shown by the fact that the incidence of sarcomas is increased eightfold to 50-fold in patients treated with radiation therapy for cancer of the breast, cervix, ovary, testes, or lymphatic system. 5,6 However, the risk of sarcoma appears to be commensurate with the dose of radiation.…”