Terwisscha van Scheltinga Sheila, Merks Johannes H M, Guerin Florent, Rogers Timothy, Craigie Ross J, Guillén Gabriela, De Corti Federica, Dall'Igna Patrizia, Dávila Fajardo Raquel, Bisogno Gianni, Ferrari Andrea, Orbach Daniel, Jenney Meriel, Chisholm Julia C, Minard-Colin Véronique, Cesen Maya, Jehanno Nina, Hiemcke-Jiwa Laura S, Zanetti Ilaria, Coppadoro Beatrice, van der Steeg Alida F W, van Noesel Max M, Wijnen Marc H W A
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
Ann Surg Oncol. 2025 Jul 24. doi: 10.1245/s10434-025-17908-3.
The European pediatric soft tissue Sarcoma Study Group (EpSSG) RMS 2005 study recommends a lymph node biopsy for extremity rhabdomyosarcoma (RMS). The aim of our study was to analyze the results of the lymph node sampling strategies used, such as sentinel node biopsy (SNB) and nodal sampling (NS), and compare the outcome of patients undergoing different nodal staging techniques.
All non-metastatic (M0) patients registered in the EpSSG RMS 2005 study with an RMS of the extremity, presenting between 2005 and 2016, were included for analysis of the lymph node sampling techniques used. The secondary objective was to compare the results and outcome for the different sampling procedures.
Of 198 patients, 144 had clinically/radiologically negative nodes (cN0), and 72/144 underwent a biopsy (26 SNB/46 NS). Final nodal status was upstaged to pN1 in 11/72 (15.3%) patients-6 after SNB and 5 after NS. In 54 radiologically malignant/suspicious-appearing nodes, 34 NS biopsies were performed, resulting in downstaging to N0 in 9/34 (26.5%) patients. 5-years overall survival (OS) of N0 patients versus N1 patients was 82.5% (95% confidence interval CI 74.7-88.0) versus 46.5% (95% CI 32.2-59.7). 5-years OS in N0 patients was not significantly different in biopsied and non-biopsied patients (p = 0.88). However, in N1 patients, survival was significantly better in biopsied compared with non-biopsied patients (p = 0.006).
Lymph node staging plays a crucial role in determining appropriate treatment strategies. Pathology of sampled lymph nodes can upstage or downstage the lymph node status, guiding treatment decisions based on the stage.
欧洲儿科软组织肉瘤研究组（EpSSG）2005年横纹肌肉瘤（RMS）研究建议对肢体横纹肌肉瘤进行淋巴结活检。我们研究的目的是分析所采用的淋巴结取样策略的结果，如前哨淋巴结活检（SNB）和淋巴结取样（NS），并比较接受不同淋巴结分期技术的患者的结局。
纳入2005年至2016年间在EpSSG 2005年RMS研究中登记的所有非转移性（M0）肢体RMS患者，以分析所使用的淋巴结取样技术。次要目标是比较不同取样程序的结果和结局。
198例患者中，144例临床/放射学检查显示淋巴结阴性（cN0），72/144例接受了活检（26例SNB/46例NS）。最终淋巴结状态在11/72例（15.3%）患者中被上调至pN1，其中SNB后6例，NS后5例。在54例放射学检查显示为恶性/可疑的淋巴结中，进行了34例NS活检，9/34例（26.5%）患者的分期下调至N0。N0患者与N1患者的5年总生存率（OS）分别为82.5%（95%置信区间CI 74.7-88.0）和46.5%（95%CI 32.2-59.7）。N0患者中，活检患者与未活检患者的5年OS无显著差异（p = 0.88）。然而，在N1患者中，活检患者的生存率明显高于未活检患者（p = 0.006）。
淋巴结分期在确定合适的治疗策略中起着关键作用。取样淋巴结的病理结果可使淋巴结状态上调或下调，从而根据分期指导治疗决策。
