Surgical resection of regional lymph node metastases in soft tissue sarcoma may not result in improved long-term survival

Regional lymph node metastases (RLNM) in cases of soft tissue sarcoma (STS) are relatively rare, with limited data available on optimal patient management and prognosis. To help address this, we present our own experiences of patients with STS RLNMs.

We performed a retrospective review of all patients with STS RLNM managed at our regional sarcoma treatment centre over a 28-year period (1987–2015). Datasets collected include patient demographics, disease characteristics, management and outcomes.

Thirty-five patients were included for analysis (21:14 male:female, median age 65 years, range 18–89). The commonest subtypes identified were undifferentiated pleomorphic sarcoma, leiomyosarcoma, liposarcoma, and rhabdomyosarcoma. Thirteen patients had RLNM at presentation. Median time for RLNM development in the remaining 22 patients was 1.9 years (range 0.4–22.7). During follow-up (median 5.8 years), 29 patients (83%) died of their disease at a median of 3 years from time of RLNM diagnosis. This gave the cohort an estimated 5-year survival of 29%. There was no difference in the survival of patients that presented with RLNM and those that developed RLNM during follow-up (p = 0.506). Five-year survival was better in patients with isolated RLNM compared with those with RLNM and visceral metastases (p < 0.001). Lymph node resections had no effect on survival (p = 0.832).

The prognosis of patients with STS RLNM is poor, albeit better than that of patients with visceral metastases. Considering the absence of a clear survival benefit identified by our analysis, we recommend that non-operative treatment is strongly considered as first-line RLNM management.

Level of evidence: Level IV, Prognostic study.