Should metastatic lymph nodes be considered at the same clinical stage as distant metastasis in soft tissue sarcomas?

Autor: Dorian Yarih Garcia-Ortega, MD, MSc, Alethia Alvarez-Cano, MD, Miguel Angel Clara-Altamirano, MD, MSc, Karla Susana Martín-Tellez, MD, Claudia Haydee Sarai Caro-Sánchez, MD, Cuauhtémoc de la Cruz Ruvalcaba-Gonzalez, MD, Hector Martinez-Said, MD, Mario Cuellar-Hubbe, MD, Kuauhyama Luna-Ortiz, MD
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Cancer Treatment and Research Communications, Vol 26, Iss , Pp 100268- (2021)
Druh dokumentu: article
ISSN: 2468-2942
DOI: 10.1016/j.ctarc.2020.100268
Popis: Introduction: Lymph node metastasis (LNM) in soft tissue sarcomas (STS) are uncommon, occurring in only 3% – 5% of all sarcomas, and are classified as Stage IV, along with distant metastasis (DM). This paper compares the prognosis of patients with lymphatic and DM, in extremity STS (eSTS). Methods: A retrospective study was carried out in a high-volume sarcoma center; 853 patients with eSTS sarcomas were identified and classified from January 1, 1997 to December 31, 2017. Cases with pathological confirmation of LNM were included. Five-year survival rates were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. Results: LNM was present in 46 of the cases (5.4%), with an overall survival of 21 months (95% confidence interval [CI], 16.7 – 25.2), compared to 18 months (95% confidence interval [CI], 14.2 – 21.7) in those with only DM. Median recurrence-free survival was 21 months (95% confidence interval [CI], 19.7 – 22.4), vs. 20 months (95% confidence interval [CI], 16.2– 23.7), respectively. LNM only and DM only had also a similar OS of 21 months (95% CI 16.7–25.2) vs 18 months (95% CI 14.2–21.7. N1M1 cases had the worse median OS with 15 months (95% confidence interval [CI], 10.9–19.7) Conclusions: Overall survival and recurrence free survival in patients with lymph node disease and metastatic disease are similar. However prognosis is worse in N1M1. Use of systemic treatment in patients with LNM is not as common as in metastatic cases, this difference in treatment and the fact that prognosis is similar suggests that both biological behavior and effect of treatment have been underestimated. A subclassification of clinical stage IV might be the next step.
Databáze: Directory of Open Access Journals
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