Sarcoma and Cutaneous Tumors

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MO_22_2784 - Predictors of Lymph Node Involvement by Soft Tissue Sarcoma: an Analysis of the National Cancer Database (NCDB)

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Predictors of Lymph Node Involvement by Soft Tissue Sarcoma: an Analysis of the National Cancer Database (NCDB)
J. A. Miccio1, V. Jairam2, S. Gao3, A. Augustyn4, O. T. Oladeru5, B. E. Onderdonk6, J. Costa7, D. Han8, S. Khan8, G. Friedlaender9, D. Lindskog9, H. Deshpande10, H. Tara11, H. Osborn12, K. B. Roberts3, and K. Patel1; 1Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, 2Yale School of Medicine, New Haven, CT, 3Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 4Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, 5Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, 6University of Chicago, Chicago, IL, 7Department of Surgical Pathology, Yale University School of Medicine, New Haven, CT, 8Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT, 9Department of Orthopaedics, Yale University School of Medicine, New Haven, CT, 10Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, 11Department of Medical Oncology, Yale University School of Medicine, New Haven, CT, 12Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, CT

Purpose/Objective(s): Lymph node (LN) metastases in soft tissue sarcoma (STS) are rare. Previous studies defining risk factors for nodal metastasis are based primarily on institutional retrospective reviews. The aim of this study is to identify risk factors associated with lymph node metastasis in non-metastatic STS patients using the National Cancer Database (NCDB).

Materials/Methods: 17,842 non-metastatic, STS patients were identified from 2004-2015. Exclusion criteria included receipt of neoadjuvant therapy and lack of pathologic nodal evaluation. The final cohort consisted of 17,262 without LN involvement, and 580 patients with LN involvement. Univariate and multivariable logistic regression models were performed to evaluate variables associated with node positivity.

Results: On multivariable analysis, several variables were associated with node positivity. These include pediatric patients (odds ratio – 2.98, p<0.001, 95% confidence interval 2.03-4.35), non-extremity location (OR – 2.09, p<0.001, 95% CI 1.65-2.65), and grade 3 tumors (grade 3 vs. grade 1, OR 4.39, p<0.001, 95% CI 2.91-6.62). Neurovascular invasion (NVI) also predicted for increased risk of positive LN (OR 2.13, p=0.001, 95% CI 1.35-3.36). Four histologic subtypes – clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid sarcoma (CARE histology)- were also associated with LN positivity (OR 3.14, p<0.001, 95% CI 2.42-4.09), while synovial sarcoma was not associated with LN positivity (Synovial histology vs. non-CARE histology, OR 0.49, 95% CI 0.27-1.01). Adult patients with non-extremity location, grade 3 tumors, and CARE histology (n=465) had a 14.2% risk of LN involvement as compared to 2.9% of adults without all three of these characteristics (p<0.001).

Conclusion: LN involvement in non-metastatic STS is associated with young age, non-extremity location, high grade, CARE histology, and NVI. High-risk adult patients – defined as non-extremity location, high grade, and CARE histology – have a 14.2% risk of LN involvement and should be considered for pathologic LN assessment.

Author Disclosure: J.A. Miccio: None. V. Jairam: None. S. Gao: None. O.T. Oladeru: None. B.E. Onderdonk: None. D. Han: Employee; VNA Community Healthcare and Hospice. Honoraria; American Osteopathic College of Dermatology, Sentinel Lymph Node Working Group. S. Khan: None. G. Friedlaender: None. K.B. Roberts: chapter author, providing periodic updates on Hematologic Malignancy chapters for on-line Rad Onc textbook; Lippincott Williams & Wilkins—Wolters Kluwer Healt. Travel Expenses; NCCN. K. Patel: None.

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