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Soft Tissue Tumors

(P 313) SIGNIFICANCE OF LYMPH NODE PROCEDURES IN SOFT TISSUE SARCOMA PATIENTS

    Author(s)

  • Anna M. Czarnecka, MD PhD (she/her/hers)

    Professor
    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

    • Co-Author(s)

  • PB

    Piotr Blonski, n/a

    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

  • OW

    Oliwia Woźniak, n/a

    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

  • PT

    Pawel Teterycz, MD PhD

    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

  • MK

    Maria Krotewicz, MD

    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

  • IK

    Iwona Kalinowska, n/a

    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsawa, Mazowieckie, Poland

  • MZ

    Marcin Zdzienicki, MD PhD

    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

  • MS

    Maciej Sałamacha, n/a

    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

  • JS

    Jacek Skoczylas, n/a

    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

  • Piotr Rutkowski, MD, PhD

    Head of Department of Soft Tissue/Bone Sarcoma and Melanoma
    Maria Sklodowska-Curie National Research Institute of Oncology
    Warsaw, Mazowieckie, Poland

Objective: Lymph node metastases in Soft Tissue Sarcomas (STS) are an infrequent clinical event. Although it is well established that lymphatic spread is associated with a poorer prognosis, there is limited data on evaluating the impact of Sentinel Lymph Node Biopsy (SLNB) and Lymph Node Dissection (LND) on treatment outcomes in these patients.

Methods: We performed a retrospective analysis of patients treated radically for sarcoma and undergoing SLNB, LND or both of these procedures at sarcoma clinic between 1998 and 2025. Relapse-free survival (RFS) and overall survival (OS) were estimated using the Kaplan–Meier method.

Results: 36 patients underwent SLNB: 21 (58%) patients had epithelioid sa, 12 (33%) – clear cell sa, 3 (8.4%) – other sarcoma. Pathologically confirmed nodal metastases were present in 15 (41.7%) cases. Patients with negative SLNB results exhibited a trend toward better long-term outcomes, with 65% (95% CI: 47.1 – 89.7) remaining relapse-free at 3 years since SLNB compared to 48.5% (95% CI: 27.8 – 84.5) among those with positive SLNB (p=0.12).
106 patients underwent LND, including 93 (88%) due to clinically overt metastases and 13 (12.3%) underwent completion LND due to positive SLNB. The most common subtypes in the first group were: epithelioid sa – in 7 (53.8%) patients and clear cell sa - 5 (38.5%) patients, while in the latter group: undifferentiated pleomorphic sa – 19 (20.4%) patients, epithelioid sa – 12 (12.9%) patients and rhabdomyosarcoma – 11 (11.8%) patients.
Median RFS since LND was notably longer for patients undergoing LND due to positive SLNB—27.1 months; 95% CI: 7.1 to not reached (NA)—compared to 10.2 months (95% CI: 7.3–20.4) than observed in the group with clinically suspected metastases. OS at 5 years since the LND was respectively: 75% (95% CI: 49.6 – 100) and 52.7% (95% CI: 40.7 – 68.5. The predominant pattern of relapse after LND was an occurrence of distant metastases.

Conclusion: Further investigation into the role of lymph node procedures in sarcoma patients including SLNB and LND is expected. The presence of lymph node metastases is associated with worse clinical outcomes.