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

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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.