Prognostic significance of lymph node metastasis and bone, major vessel, or nerve involvement in adults with high-grade soft tissue sarcomas

Abstract

Two hundred sixty‐seven patients with high‐grade (G₂ or G₃) soft tissue sarcomas (STS) were examined. All tumors were removed by resection (marginal or wide) or amputation. Seventy‐four patients had T₃ primary tumors invading neurovascular structures (n = 41) or bone (n = 33), and 29 patients had histologically confirmed metastases to the regional nodes removed at the time of definitive surgery. The estimated 5‐year and 10‐year survival rates for patients in Stage IIa, b or IIIa, b were 44% and 37%, respectively. For patients with neurovascular or bone invasion the survival rates were 24% and 15%, respectively. For patients with lymph node metastases the survival rates were 10% and 3%, respectively. Survival of patients with primary sarcomas invading the nerve, vessel, or bone was significantly better than that of patients with lymph node metastases (P = 0.002). Survival also was distinctly different between patients with nerve or vessel invasion who had a 5‐year survival rate of 32%, and patients with bone invasion who had a 5‐year survival rate of 15% (P = 0.002). These findings suggest that the current staging system for STS should be reexamined. Also, patients with nerve or vessel invasion should be assigned a IIIc, position, those with bone invasion a IIIc₂ position, and those with lymph node metastases a IVa position in the staging system.