Abstract
Purpose
The aim of this study was to examine the clinical course of patients with the rare finding of regional lymph node metastasis (RLNM) from soft tissue sarcoma.
Materials and methods
Data from 28 out of 1,597 consecutive soft tissue sarcoma patients with RLNM were from the patients’ charts and interviewing patients and general practitioners. Survival, including possible influencing factors, was statistically calculated.
Results
RLNM was seen in 21.4% for epithelioid sarcoma and 17.6% for clear cell sarcoma. All other entities presented RLNM rates below 10%. At follow-up after an average of 9.6 years, only three patients were alive with no evidence of disease. Survival was independent from surgical resection status of the primary tumor and the RLNM as well as from adjuvant radiation and chemotherapy. Tumor entity as well as the length of the time period from primary to RLNM affect survival.
Conclusions
Surgical treatment as well as radiation and chemotherapy may improve survival in selected cases but probably have their value much more in terms of local disease control and improvement life quality of patients who probably already suffer from an aggressive systemic disease at time of nodal involvement.
Similar content being viewed by others
References
Ariel IM (1988) Incidence of metastases to lymph nodes from soft-tissue sarcomas. Semin Surg Oncol 4:27–29 doi:10.1002/ssu.2980040107
Behranwala KA, A’Hern R, Omar AM et al (2004) Prognosis of lymph node metastasis in soft tissue sarcoma. Ann Surg Oncol 11:714–719 doi:10.1245/ASO.2004.04.027
Blazer DG, Sabel MS, Sondak VK (2003) Is there a role for sentinel lymph node biopsy in the management of sarcoma? Surg Oncol 12:201–206 doi:10.1016/S0960-7404(03)00030-6
Stelzner F, Friedrichs N, Buttner R et al (2005) Lymph vascularity and lymph node metastases on PET and PET-CT: immunohistological and clinical observations. Chirurg 76:493–500 doi:10.1007/s00104-005-1015-0
Riad S, Griffin AM, Liberman B et al (2004) Lymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res 426:129–134. doi:10.1097/01.blo.0000141660.05125.46
Mazeron JJ, Suit HD (1987) Lymph nodes as sites of metastases from sarcomas of soft tissue. Cancer 60:1800–1808 doi:10.1002/1097-0142(19871015)60:8<1800::AID-CNCR2820600822>3.0.CO;2-N
Billingsley KG, Burt ME, Jara E et al (1999) Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival. Ann Surg 229:602–610 discussion 610–602) doi:10.1097/00000658-199905000-00002
Vezeridis MP, Moore R, Karakousis CP (1983) Metastatic patterns in soft-tissue sarcomas. Arch Surg 118:915–918
Skinner KA, Eilber FR (1996) Soft tissue sarcoma nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am 5:121–127
Finley JW, Hanypsiak B, McGrath B et al (2001) Clear cell sarcoma: the Roswell Park experience. J Surg Oncol 77:16–20 doi:10.1002/jso.1057
Fong Y, Coit DG, Woodruff JM et al (1993) Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 217:72–77 doi:10.1097/00000658-199301000-00012
Weingrad DN, Rosenberg SA (1978) Early lymphatic spread of osteogenic and soft-tissue sarcomas. Surgery 84:231–240
Cai H, Shi YQ, Wang YN et al (2004) Realization of clinical diagnoses and treatment for dermatofibrosarcoma protuberans. Zhonghua Wai Ke Za Zhi 42:678–682
Lawrence W, Hays DM, Heyn R et al (1987) Lymphatic metastases with childhood rhabdomyosarcoma. A report from the Intergroup Rhabdomyosarcoma Study.. Cancer 60:910–915 doi:10.1002/1097-0142(19870815)60:4<910::AID-CNCR2820600433>3.0.CO;2-8
Weiss SW, Enzinger FM (1978) Malignant fibrous histiocytoma: an analysis of 200 cases. Cancer 41:2250–2266 doi:10.1002/1097-0142(197806)41:6<2250::AID-CNCR2820410626>3.0.CO;2-W
Coindre JM, Terrier P, Bui NB et al (1996) Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol 14:869–877
Pritchard DJ, Soule EH, Taylor WF et al (1974) Fibrosarcoma—a clinicopathologic and statistical study of 199 tumors of the soft tissues of the extremities and trunk. Cancer 33:888–897 doi:10.1002/1097-0142(197403)33:3<888::AID-CNCR2820330339>3.0.CO;2-C
Naka N, Ohsawa M, Tomita Y et al (1996) Prognostic factors in angiosarcoma: a multivariate analysis of 55 cases. J Surg Oncol 61:170–176 doi:10.1002/(SICI)1096-9098(199603)61:3<170::AID-JSO2>3.0.CO;2-8
Gaakeer HA, Albus-Lutter CE, Gortzak E et al (1988) Regional lymph node metastases in patients with soft tissue sarcomas of the extremities, what are the therapeutic consequences? Eur J Surg Oncol 14:151–156
Ross HM, Lewis JJ, Woodruff JM et al (1997) Epithelioid sarcoma: clinical behavior and prognostic factors of survival. Ann Surg Oncol 4:491–495 doi:10.1007/BF02303673
Ruka W, Emrich LJ, Driscoll DL et al (1988) Prognostic significance of lymph node metastasis and bone, major vessel, or nerve involvement in adults with high-grade soft tissue sarcomas. Cancer 62:999–1006 doi:10.1002/1097-0142(19880901)62:5<999::AID-CNCR2820620527>3.0.CO;2-N
Russell WO, Cohen J, Enzinger F et al (1977) A clinical and pathological staging system for soft tissue sarcomas. Cancer 40:1562–1570 doi:10.1002/1097-0142(197710)40:4<1562::AID-CNCR2820400428>3.0.CO;2-6
Shiu MH, Castro EB, Hajdu SI et al (1975) Surgical treatment of 297 soft tissue sarcomas of the lower extremity. Ann Surg 182:597–602 doi:10.1097/00000658-197511000-00011
Hohenberger P (2000) Soft tissue sarcoma of high grade—a primary systemic disease? Eur J Cancer 36:688–690 doi:10.1016/S0959-8049(00)00061-7
Lehnhardt M, Kuhnen C, Drucke D et al (2004) Liposarcoma of the extremities: recent developments in surgical therapy—analysis of 167 patients. Chirurg 75:1182–1190 doi:10.1007/s00104-004-0900-2
Steinau HU, Hebebrand D, Torres A et al (1998) Surgical management of soft tissue sarcomas: principles of resection and reconstructive plastic procedures. Schweiz Rundsch Med Prax 87:1061–1065
Steinau HU, Homann HH, Drucke D et al (2001) Resection method and functional restoration in soft tissue sarcomas of the extremities. Chirurg 72:501–513 doi:10.1007/s001040051339
Lehnhardt M, Daigeler A, Hauser J et al (2008) The value of expert second opinion in diagnosis of soft tissue sarcomas. J Surg Oncol 97:40–43
Spillane AJ, Thomas JM, Fisher C (2000) Epithelioid sarcoma: the clinicopathological complexities of this rare soft tissue sarcoma. Ann Surg Oncol 7:218–225 doi:10.1007/BF02523657
Collin C, Godbold J, Hajdu S et al (1987) Localized extremity soft tissue sarcoma: an analysis of factors affecting survival. J Clin Oncol 5:601–612
Thomford NR, Woolner LB, Clagett OT (1965) The surgical treatment of metastatic tumors in the lungs. J Thorac Cardiovasc Surg 49:357–363
Huth JF, Holmes EC, Vernon SE et al (1980) Pulmonary resection for metastatic sarcoma. Am J Surg 140:9–16 doi:10.1016/0002-9610(80)90411-0
van Geel AN, Pastorino U, Jauch KW et al (1996) Surgical treatment of lung metastases: The European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma group study of 255 patients. Cancer 77:675–682 doi:10.1002/(SICI)1097-0142(19960215)77:4<675::AID-CNCR13>3.0.CO;2-Y
van Akkooi AC, Verhoef C, van Geel AN et al (2006) Sentinel node biopsy for clear cell sarcoma. Eur J Surg Oncol 32:996–999 doi:10.1016/j.ejso.2006.03.044
Acknowledgments
We thank the Department of Biometry and Epidemiology, Ruhr-University, Bochum, R. Klaaßen-Mielke for assistance with statistical analysis and Amanda Daigeler for her formal English revision of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Daigeler, A., Kuhnen, C., Moritz, R. et al. Lymph node metastases in soft tissue sarcomas—a single center analysis of 1,597 patients. Langenbecks Arch Surg 394, 321–329 (2009). https://doi.org/10.1007/s00423-008-0371-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-008-0371-x