Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities.
BACKGROUND AND OBJECTIVES
Synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid (SCARE) soft tissue sarcoma are at risk for nodal involvement, although the nodal positivity rates and impact on prognostication in clinically node negative patients are not well described.


METHODS
Patients with extremity SCARE sarcoma without clinical nodal involvement undergoing surgical resection in the National Cancer Database (2004-2017) were included. Logistic regression was used to evaluate the likelihood of nodal surgery and nodal positivity. Kaplan-Meier method and Cox regression were used to assess associations of nodal status to overall survival.


RESULTS
We included 4158 patients, and 669 patients (16%) underwent regional lymph node surgery (RLNS). On multivariable logistic analysis, patients with epithelioid (odds ratio [OR]: 3.77; p < .001) and clear cell (OR: 6.38; p < .001) were most likely to undergo RLNS. Forty-five patients (7%) had positive nodes. Clear cell sarcoma (14%) and angiosarcoma (13%) had the highest rates of nodal positivity. Patients with positive nodes had reduced 5-year overall survival, and the stratification was largest in clear cell and angiosarcoma.


CONCLUSION
Discordance exists between selection for pathologic nodal evaluation and factors associated with nodal positivity. Clinically node negative patients with clear cell and angiosarcoma should be considered for pathologic nodal evaluation.
['Maduekwe|Ugwuji N|UN|', 'Herb|Joshua N|JN|http://orcid.org/0000-0002-0503-3739', 'Esther|Robert J|RJ|', 'Kim|Hong Jin|HJ|', 'Spanheimer|Philip M|PM|http://orcid.org/0000-0001-8644-0178']
D000293:Adolescent D000328:Adult D000368:Aged D016208:Databases, Factual D005121:Extremities D006801:Humans D008875:Middle Aged D009367:Neoplasm Staging D012189:Retrospective Studies D012509:Sarcoma D012983:Soft Tissue Neoplasms D015996:Survival Rate D055815:Young Adult
angiosarcoma rhabdomyosarcoma clear cell sarcoma SLNB epithelioid sarcoma synovial sarcoma