Prognostic significance of lymph node metastasis and bone, major vessel, or nerve involvement in adults with high-grade soft tissue sarcomas.

Two hundred sixty-seven patients with high-grade (G2 or G3) soft tissue sarcomas (STS) were examined. All tumors were removed by resection (marginal or wide) or amputation. Seventy-four patients had T3 primary tumors invading neurovascular structures (n = 41) or bone (n = 33), and 29 patients had histologically confirmed metastases to the regional nodes removed at the time of definitive surgery. The estimated 5-year and 10-year survival rates for patients in Stage IIa, b or IIIa, b were 44% and 37%, respectively. For patients with neurovascular or bone invasion the survival rates were 24% and 15%, respectively. For patients with lymph node metastases the survival rates were 10% and 3%, respectively. Survival of patients with primary sarcomas invading the nerve, vessel, or bone was significantly better than that of patients with lymph node metastases (P = 0.002). Survival also was distinctly different between patients with nerve or vessel invasion who had a 5-year survival rate of 32%, and patients with bone invasion who had a 5-year survival rate of 15% (P = 0.002). These findings suggest that the current staging system for STS should be reexamined. Also, patients with nerve or vessel invasion should be assigned a IIIc1 position, those with bone invasion a IIIc2 position, and those with lymph node metastases a IVa position in the staging system.