Gaakeer H A, Albus-Lutter C E, Gortzak E, Zoetmulder F A
Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis), Amsterdam.
Eur J Surg Oncol. 1988 Apr;14(2):151-6.
In the period 1977-1983, 183 adult patients with soft tissue sarcomas of the extremities were treated in the Netherlands Cancer Institute. One hundred and seventy-one patients had initially operable tumors. Fifteen patients (8.2%) developed regional lymph node metastases (RLNM) during the course of their disease. Only two patients (1.2%) developed RLNM as first site of tumor recurrence. The incidence of RLNM varied according to the histological subtypes: liposarcoma: 1/64, fibrosarcoma: 1/12, tendosynovial sarcoma: 5/24, unclassifiable sarcoma: 3/8. The outcome in patients with RLNM was invariably fatal. In all cases with RNLM distant metastases were present either at the time RLNM were found or shortly afterwards (median 4 months). Based on this experience we now consider RLNM in soft tissue sarcoma an expression of systemic tumor spread, which should be treated as such. We find no indication for elective lymph node dissection as part of the initial treatment of soft tissue sarcoma of any histological subtype. Therapeutic lymph node dissection might be indicated as part of the palliative management.
1977年至1983年期间，荷兰癌症研究所对183例成人肢体软组织肉瘤患者进行了治疗。171例患者最初的肿瘤可以手术切除。15例患者（8.2%）在病程中出现了区域淋巴结转移（RLNM）。只有2例患者（1.2%）以RLNM作为肿瘤复发的首发部位。RLNM的发生率因组织学亚型而异：脂肪肉瘤：1/64，纤维肉瘤：1/12，腱鞘滑膜肉瘤：5/24，无法分类的肉瘤：3/8。发生RLNM的患者结局均为死亡。在所有发生RLNM的病例中，发现RLNM时或之后不久（中位时间4个月）均存在远处转移。基于这一经验，我们现在认为软组织肉瘤中的RLNM是全身肿瘤播散的一种表现，应按此进行治疗。我们没有发现对任何组织学亚型的软组织肉瘤进行初始治疗时行选择性淋巴结清扫的指征。治疗性淋巴结清扫可能作为姑息治疗的一部分。
