Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, Hubei Province, China.
J Orthop Surg Res. 2022 Mar 18;17(1):167. doi: 10.1186/s13018-022-03050-3.
This study sought to define the risk factors for lymph node metastasis (LNM) of soft tissue sarcomas (STS) of the head, neck, and extremities, and the clinical significance of negative lymph node dissection (NLND).
STS patient data in the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2015 were extracted and pooled. Logistics regression analysis was used to identify risk factors for LNM, Cox proportional hazards and Fine-Grey's models were used for survival analysis, and Propensity score matching analysis (PSM) was used to assess the impact of NLND on patient prognosis.
A total of 3276 patients were enrolled in the study, of whom 283 (8.6%) developed LNM. Rhabdomyosarcoma had the highest rate of LNM (25.3%), followed by clear cell sarcoma (16.8%) and epithelioid sarcoma (12.4%), while leiomyosarcoma had the lowest rate of LNM (1.3%). Sex, tumor size, grade, histology, and site were significantly associated with LNM. For specific histologic subtypes of STS, NLND significantly improves overall survival (HR: 0.718, 95%CI 0.535-0.962; P = 0.026) and cancer-specific survival (HR: 0.699, 95%CI 0.506-0.967; P = 0.031) and reduces cancer-specific mortality (Gray's test, P = 0.017). However, NLND did not improve overall survival (P = 0.46) or reduce cancer-specific mortality (Gray's test, P = 0.772) of patients with leiomyosarcoma.
Histology is an independent risk factor for LNM in STS of the head, neck, and extremities. Prophylactic NLND treatment was necessary and had a clinical benefit for patients with STS who were at high risk for LNM but had no significant impact on the prognosis of patients with leiomyosarcoma.
本研究旨在确定头颈部和四肢软组织肉瘤（STS）淋巴结转移（LNM）的风险因素，以及阴性淋巴结清扫术（NLND）的临床意义。
从 1988 年至 2015 年，从监测、流行病学和最终结果（SEER）数据库中提取 STS 患者数据并进行汇总。使用逻辑回归分析识别 LNM 的风险因素，使用 Cox 比例风险和 Fine-Grey 模型进行生存分析，使用倾向评分匹配分析（PSM）评估 NLND 对患者预后的影响。
共纳入 3276 例患者，其中 283 例（8.6%）发生 LNM。横纹肌肉瘤的 LNM 发生率最高（25.3%），其次是透明细胞肉瘤（16.8%）和上皮样肉瘤（12.4%），而平滑肌肉瘤的 LNM 发生率最低（1.3%）。性别、肿瘤大小、分级、组织学和部位与 LNM 显著相关。对于 STS 的特定组织学亚型，NLND 显著改善总生存率（HR：0.718，95%CI 0.535-0.962；P=0.026）和癌症特异性生存率（HR：0.699，95%CI 0.506-0.967；P=0.031），降低癌症特异性死亡率（Gray 检验，P=0.017）。然而，NLND 并未改善平滑肌肉瘤患者的总生存率（P=0.46）或降低癌症特异性死亡率（Gray 检验，P=0.772）。
组织学是头颈部和四肢 STS 发生 LNM 的独立危险因素。对于 LNM 风险较高的 STS 患者，预防性 NLND 治疗是必要的，并且具有临床获益，但对平滑肌肉瘤患者的预后没有显著影响。
