Incidence and survival outcomes of patients with high-grade appendicular bone sarcoma and isolated regional lymph node metastasis: A national cohort database study

Angad Ds Bedi; Lotte R van der Linden; Marcos R Gonzalez; Daniel Karczewski; Paul C Jutte; Santiago A Lozano-Calderon

doi:10.1016/j.ejso.2024.108399

Incidence and survival outcomes of patients with high-grade appendicular bone sarcoma and isolated regional lymph node metastasis: A national cohort database study

Eur J Surg Oncol. 2024 May 10;50(7):108399. doi: 10.1016/j.ejso.2024.108399. Online ahead of print.

Authors

Angad Ds Bedi¹, Lotte R van der Linden², Marcos R Gonzalez³, Daniel Karczewski⁴, Paul C Jutte⁵, Santiago A Lozano-Calderon⁶

Affiliations

¹ Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: a.d.s.bedi@umcg.nl.
² Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: lrvanderlinden@mgh.harvard.edu.
³ Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: mgonzalez52@mgh.harvard.edu.
⁴ Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: daniel.karczewski@charite.de.
⁵ Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: p.c.jutte@umcg.nl.
⁶ Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: slozanocalderon@mgh.harvard.edu.

PMID: 38754315
DOI: 10.1016/j.ejso.2024.108399

Abstract

Background: While distant metastases in primary bone sarcomas have been extensively studied, the impact of isolated regional lymph node (LN) metastasis on survival remains unknown. In patients with primary bone sarcomas, we sought to assess the prevalence of isolated regional LN metastasis and the survival of this population.

Methods: A total of 6651 patients with histologically-confirmed high-grade osteosarcoma, Ewing sarcoma, or chondrosarcoma were retrieved from the SEER database. We defined four subgroups for our analysis: localized disease (N0 M0), isolated regional LN metastasis (N1 M0), isolated distant metastasis (N0 M1), and combined regional LN and distant metastasis (N1 M1). Disease-specific survival (DSS) was assessed using the Kaplan-Meier method.

Results: Prevalence of isolated regional LN metastasis (N1 M0) was highest in Ewing sarcoma (27/1097; 3.3 %), followed by chondrosarcoma (18/1702; 1.4 %) and osteosarcoma (26/3740; 0.9 %). In all three histologies, patients with isolated regional LN metastasis had a worse 2-year, 5-year, and 10-year DSS than those with localized disease. Chondrosarcoma patients with isolated regional LN (N1 M0) metastasis had a significantly higher DSS in comparison to those with only distant metastasis (N0 M1) at the 5- and 10-year marks; for osteosarcoma and Ewing sarcoma, only a pattern towards higher survival was seen. Risk factors for presenting isolated regional LN metastasis included tumor location in lower-limb (OR = 2.01) or pelvis (OR = 2.49), diagnosis of Ewing sarcoma (OR = 2.98), and tumor >10 cm (OR = 1.96).

Conclusions: Isolated regional LN metastases in primary bone sarcomas is an infrequent presentation associated with worse survival than localized disease.

Level of evidence: III.

Keywords: Bone sarcomas; Metastasis; Regional lymph nodes; Risk factors; Survival.

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