Shalaby Mohamed, Allam Rasha M, Elkordy Mohamed A, Taher Mohammad
Department of Surgical Oncology, National Cancer Institute, Cairo University, Kasr Al Eini St., Fom El Khalig Sq., P.C. 11796, Cairo, Egypt.
Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
Int J Clin Oncol. 2025 Feb;30(2):407-416. doi: 10.1007/s10147-024-02674-1. Epub 2024 Dec 19.
Lymph node metastasis (LNM) in soft tissue sarcoma (STS) of the extremities is relatively rare. We aimed to evaluate the prognosis and the survival of patients with LNM and correlate them to the pattern of metastasis.
A retrospective study of patients diagnosed with STS of the extremities from 2015 to 2019.
111/1506 patients (7.4%) had LNM. Nodal metastasis was correlated significantly with old age, advanced tumor stages, high-grade tumors, presence of Lymphovascular invasion (LVI), and resection margins < = 2 cm. Metachronous LNM was documented in 96 patients (86.5%) and synchronous LNM in 15 patients (13.5%). The 6-year overall survival (OS) was 36.3% for those with LNM and 52.9% for those without LNM. The 6-year disease-free survival (DFS) was 5.7% for those with LNM and 32.6% for those without LNM. Metachronus pattern of LNM showed a significantly poorer outcome regarding 6-year OS and DFS than the synchronous pattern.
LNM significantly negatively predicts OS and DFS in the extremities' STS. In particular, the metachronous pattern of LNM indicates a grave prognosis as these patients are supposed to harbor an occult LNM at presentation and were not subjected to lymphadenectomy at their initial primary treatment surgery. Therefore, seeking a valid noninvasive diagnostic tool such as sentinel lymph node biopsy to detect nodal metastasis is necessary.
肢体软组织肉瘤（STS）发生淋巴结转移（LNM）相对少见。我们旨在评估LNM患者的预后和生存情况，并将其与转移模式相关联。
对2015年至2019年诊断为肢体STS的患者进行回顾性研究。
1506例患者中有111例（7.4%）发生LNM。淋巴结转移与老年、肿瘤晚期、高级别肿瘤、存在淋巴管侵犯（LVI）以及手术切缘≤2 cm显著相关。96例患者（86.5%）为异时性LNM，15例患者（13.5%）为同时性LNM。发生LNM患者的6年总生存率（OS）为36.3%，未发生LNM患者的为52.9%。发生LNM患者的6年无病生存率（DFS）为5.7%，未发生LNM患者的为32.6%。异时性LNM模式在6年OS和DFS方面的结局明显比同时性模式差。
LNM对肢体STS的OS和DFS有显著的负向预测作用。特别是，异时性LNM模式提示预后严重，因为这些患者在初诊时可能已有隐匿性LNM，且在初次原发治疗手术时未接受淋巴结清扫术。因此，寻求一种有效的非侵入性诊断工具，如前哨淋巴结活检来检测淋巴结转移是必要的。
