Early Lymph Node Metastasis May Predict Poor Prognosis in Soft Tissue Sarcoma

Emori, Makoto; Tsuchie, Hiroyuki; Nagasawa, Hiroyuki; Sonoda, Tomoko; Tsukamoto, Arihiko; Shimizu, Junya; Murahashi, Yasutaka; Emi, Mitsuru; Takada, Kohichi; Murase, Kazuyuki; Iesato, Kotoe; Igarashi, Keita; Hori, Tsukasa; Yamamoto, Masaki; Sugita, Shintaro; Miyakoshi, Naohisa; Hasegawa, Tadashi; Shimada, Yasuhiro; Yamashita, Toshihiko

doi:10.1155/2019/6708474

Cited by 11 publications

(9 citation statements)

References 17 publications

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“…Some potential explanations are that changes in tumor size may be closely related to its biological behavior and LNM is regarded as a prerequisite for malignant tumor invasion and metastasis. 30 , 31 David et al also supported the notion that lymph node positivity is a predictive sign of biological aggressiveness and distant metastasis. 32 Taken together, STS patients with the characteristics of higher grade, histologic type of synovial sarcoma, LNM, and tumor size larger than 10 cm were associated with increased risk of LM at initial diagnosis and justified more thorough chest computer tomography scanning.…”

Section: Discussionmentioning

confidence: 88%

Score for the Risk and Overall Survival of Lung Metastasis in Patients First Diagnosed With Soft Tissue Sarcoma: A Novel Nomogram-Based Risk Assessment System

Fan

Chi

Tong

et al. 2022

Technol Cancer Res Treat

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Background: Metastatic soft tissue sarcoma (STS) patients have a poor prognosis with a 3-year survival rate of 25%. About 30% of them present lung metastases (LM). This study aimed to construct 2 nomograms to predict the risk of LM and overall survival of STS patients with LM. Materials and Methods: The data of patients were derived from the Surveillance, Epidemiology, and End Results database during the period of 2010 to 2015. Logistic and Cox analysis was performed to determine the independent risk factors and prognostic factors of STS patients with LM, respectively. Afterward, 2 nomograms were, respectively, established based on these factors. The performance of the developed nomogram was evaluated with receiver operating characteristic curves, area under the curve (AUC) calibration curves, and decision curve analysis (DCA). Results: A total of 7643 patients with STS were included in this study. The independent predictors of LM in first-diagnosed STS patients were N stage, grade, histologic type, and tumor size. The independent prognostic factors for STS patients with LM were age, N stage, surgery, and chemotherapy. The AUCs of the diagnostic nomogram were 0.806 in the training set and 0.799 in the testing set. For the prognostic nomogram, the time-dependent AUC values of the training and testing set suggested a favorable performance and discrimination of the nomogram. The 1-, 2-, and 3-year AUC values were 0.698, 0.718, and 0.715 in the training set, and 0.669, 0.612, and 0717 in the testing set, respectively. Furthermore, for the 2 nomograms, calibration curves indicated satisfactory agreement between prediction and actual survival, and DCA indicated its clinical usefulness. Conclusion: In this study, grade, histology, N stage, and tumor size were identified as independent risk factors of LM in STS patients, age, chemotherapy surgery, and N stage were identified as independent prognostic factors of STS patients with LM, these developed nomograms may be an effective tool for accurately predicting the risk and prognosis of newly diagnosed patients with LM.

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Section: Discussionmentioning

confidence: 88%

Score for the Risk and Overall Survival of Lung Metastasis in Patients First Diagnosed With Soft Tissue Sarcoma: A Novel Nomogram-Based Risk Assessment System

Fan

Chi

Tong

et al. 2022

Technol Cancer Res Treat

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“…Despite the low incidence, the confirmation of LNM seems to be a clinical expression of the biological aggressiveness of the STS, patients with LNM are prone to have unsatisfactory survival outcome ( 6 ). The 5-year survival for patients with STS with LNM is reported to range from 12.5% to 45.5% ( 7 , 8 ), similar to the 5-year overall survival (OS) rate in patients with oligometastatic disease localized to the lungs, which is estimated to be approximately 25% to 40% ( 9 ). Because of the dismal prognosis, patients with LNM would be considered to be in the advanced stage of the disease.…”

Section: Introductionmentioning

confidence: 83%

Early distinction of lymph node metastasis in patients with soft tissue sarcoma and individualized survival prediction using the online available nomograms: A population-based analysis

Tong

Cui

et al. 2022

Front. Oncol.

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BackgroundThe presence of metastatic tumor cells in regional lymph nodes is considered as a significant indicator for inferior prognosis. This study aimed to construct some predictive models to quantify the probability of lymph node metastasis (LNM) and survival rate of patients with soft tissue sarcoma (STS) with LNM.MethodsResearch data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2017, and data of patients with STS from our medical institution were collected to form an external testing set. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for developing LNM. On the basis of the identified variables, we developed a diagnostic nomogram to predict the risk of LNM in patients with STS. Those patients with STS presenting with LNM were retrieved to build a cohort for identifying the independent prognostic factors through univariate and multivariate Cox regression analysis. Then, two nomograms incorporating the independent prognostic predictors were developed to predict the overall survival (OS) and cancer-specific survival (CSS) for patients with STS with LNM. Kaplan–Meier (K-M) survival analysis was conducted to study the survival difference. Moreover, validations of these nomograms were performed by the receiver operating characteristic curves, the area under the curve, calibration curves, and the decision curve analysis (DCA).ResultsA total of 16,601 patients with STS from the SEER database were enrolled in our study, of which 659 (3.97%) had LNM at the initial diagnosis. K-M survival analysis indicated that patients with LNM had poorer survival rate. Sex, histology, primary site, grade, M stage, and T stage were found to be independently related with development of LNM in patients with STS. Age, grade, histology, M stage, T stage, chemotherapy, radiotherapy, and surgery were identified as the independent prognostic factors for OS of patients with STS with LNM, and age, grade, M stage, T stage, radiotherapy, and surgery were determined as the independent prognostic factors for CSS. Subsequently, we constructed three nomograms, and their online versions are as follows: https://tyxupup.shinyapps.io/probabilityofLNMforSTSpatients/, https://tyxupup.shinyapps.io/OSofSTSpatientswithLNM/, and https://tyxupup.shinyapps.io/CSSofSTSpatientswithLNM/. The areas under the curve (AUCs) of diagnostic nomogram were 0.839 in the training set, 0.811 in the testing set, and 0.852 in the external testing set. For prognostic nomograms, the AUCs of 24-, 36-, and 48-month OS were 0.820, 0.794, and 0.792 in the training set and 0.759, 0.728, and 0.775 in the testing set, respectively; the AUCs of 24-, 36-, and 48-month CSS were 0.793, 0.777, and 0.775 in the training set and 0.775, 0.744, and 0.738 in the testing set, respectively. Furthermore, calibration curves suggested that the predicted values were consistent with the actual values. For the DCA, our nomograms showed a superior net benefit across a wider scale of threshold probabilities for the prediction of risk and survival rate for patients with STS with LNM.ConclusionThese newly proposed nomograms promise to be useful tools in predicting the risk of LNM for patients with STS and individualized survival prediction for patients with STS with LNM, which may help to guide clinical practice.

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“…Upon univariate analysis, negative prognostic factors for metastasis included T-score, tumor size, LN involvement, LVI, local recurrence, and tumor location. 27,43,44 Multivariate analysis revealed that tumor size ≥7 cm, LN involvement, and LVI all led to more than twofold increases in the risk of metastasis. This implies that patients with increased tumor size, nodal involvement, and vascular invasion had worse clinical outcomes (Table 3, Figures 1B and 3).…”

Section: Discussionmentioning

confidence: 99%

Prognostic and predictive factors in undifferentiated pleomorphic sarcoma: A long‐term study from a large tertiary care urban center

Gonzalez

Clunk

Bedi

et al. 2023

Journal of Surgical Oncology

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Background and Objectives Undifferentiated pleomorphic sarcoma (UPS) is an aggressive type of soft tissue sarcoma (STS) with high rates of metastatic disease and local recurrence. We sought to identify risk factors for local recurrence, metastasis, and overall death, and assess their impact on overall survival (OS), local recurrence‐free survival (LRFS), and metastasis‐free survival (MFS). Methods A total of 386 cases of UPS treated at our institution from 1980 to 2020 were included. Cox proportional hazards regression was used to identifying risk factors for death, local recurrence, and/or metastasis. Using the Kaplan–Meier method, we assessed OS, LRFS, and MFS. Results Sixty‐six (17%) and 121 (30%) patients with UPS developed local recurrence or metastasis, respectively. Lymph node (LN) involvement was present in 13.5% of patients. The most affected organ in patients with metastatic disease was the lungs (76.9%). Age ≥ 60 (hazard ratio [HR] = 2.42) and size ≥7 cm (HR = 1.52) were some of the significant risk factors for overall death. LN involvement was an important risk factor for both LR (HR = 2.79) and distant metastasis (HR = 5.73). Conclusions UPS displays high rates of metastatic disease and local recurrence. Using a tumor size cutoff value of 7 cm yields superior prognostic value than the standard STS T‐score thresholds. Lymphovascular invasion is an important risk factor for the development of metastasis.

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Early Lymph Node Metastasis May Predict Poor Prognosis in Soft Tissue Sarcoma

Cited by 11 publications

References 17 publications

Score for the Risk and Overall Survival of Lung Metastasis in Patients First Diagnosed With Soft Tissue Sarcoma: A Novel Nomogram-Based Risk Assessment System

Score for the Risk and Overall Survival of Lung Metastasis in Patients First Diagnosed With Soft Tissue Sarcoma: A Novel Nomogram-Based Risk Assessment System

Early distinction of lymph node metastasis in patients with soft tissue sarcoma and individualized survival prediction using the online available nomograms: A population-based analysis

Prognostic and predictive factors in undifferentiated pleomorphic sarcoma: A long‐term study from a large tertiary care urban center

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