National Cancer Institute (Instituto Nacional de Cancerología) Mexico City, Mexico.
Christus Muguerza Alta Especialidad, Monterrey Nuevo León. Mexico.
Cancer Treat Res Commun. 2021;26:100268. doi: 10.1016/j.ctarc.2020.100268. Epub 2020 Dec 10.
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).
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.
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.
软组织肉瘤（STS）中的淋巴结转移（LNM）并不常见，仅占所有肉瘤的 3%-5%，并与远处转移（DM）一起归类为 IV 期。本文比较了肢体 STS（eSTS）中伴有淋巴和 DM 的患者的预后。
对一家大容量肉瘤中心进行了回顾性研究；从 1997 年 1 月 1 日至 2017 年 12 月 31 日，共确定并分类了 853 例 eSTS 肉瘤患者。纳入了有 LNM 病理证实的病例。使用 Kaplan-Meier 方法和 Cox 比例风险模型分析 5 年生存率。
46 例（5.4%）存在 LNM，总生存期为 21 个月（95%置信区间[CI]，16.7-25.2），而仅 DM 的患者为 18 个月（95%CI，14.2-21.7）。无复发生存中位数为 21 个月（95%CI，19.7-22.4），而仅 DM 的患者为 20 个月（95%CI，16.2-23.7）。LNM 仅和 DM 仅的 OS 也相似，分别为 21 个月（95%CI，16.7-25.2）和 18 个月（95%CI，14.2-21.7）。N1M1 病例的中位 OS 最差，为 15 个月（95%CI，10.9-19.7）。
伴有淋巴结疾病和转移性疾病的患者的总生存和无复发生存相似。然而，N1M1 患者的预后更差。在 LNM 患者中使用全身治疗并不像在转移性病例中那样常见，这种治疗上的差异以及预后相似表明，两者的生物学行为和治疗效果都被低估了。下一步可能是对临床 IV 期进行亚分类。
