title: Examination of national lymph node evaluation practices for adult extremity soft tissue sarcoma.
abstract: OBJECTIVE
  Lymph node evaluation recommendations for extremity soft tissue sarcoma (ESTS) are absent from national guidelines. Our objectives were (1) to assess rates and predictors of nodal evaluation, and (2) to assess rates and predictors of nodal metastases.
  
  
  METHODS
  ESTS patients from the National Cancer Data Base (2000-2009) were assessed, and regression models were used to identify factors associated with nodal evaluation and metastases.
  
  
  RESULTS
  Of 27,536 ESTS patients, 1,924 (7%) underwent nodal evaluation, and of these, 290 (15%) had nodal metastases. Nodal evaluation was most frequently performed for rhabdomyosarcoma (15.6%), angiosarcoma (10.0%), clear cell sarcoma (39.3%), epithelioid sarcoma (28.1%), and synovial sarcoma (9.3%). On multivariable analysis, factors associated with nodal evaluation included histologic subtype, tumor size, and grade. Nodal metastasis rates were highest among patients with rhabdomyosarcoma (32.1%), angiosarcoma (24.1%), clear cell sarcoma (27.7%), and epithelioid sarcoma (31.8%). On multivariable analysis, factors associated with nodal metastases included histologic subtype, tumor size, and grade.
  
  
  CONCLUSIONS
  Nodal evaluation rates are highest among certain expected subtypes but are generally low. However, nodal metastasis rates for many histologic subtypes in patients selected for lymph node evaluation may be higher than previously reported. Multi-institutional studies should address nodal evaluation for ESTS.
authors.affiliation: Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois; Department of Surgery, Surgical Oncology and Quality Improvement Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Sherman
authors.forename: Christine V
authors.initials: CV
authors.lastname: Kinnier
authors.forename: Domenico A
authors.initials: DA
authors.lastname: Farina
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Wayne
authors.forename: William B
authors.initials: WB
authors.lastname: Laskin
authors.forename: Mark
authors.initials: M
authors.lastname: Agulnik
authors.forename: Samer
authors.initials: S
authors.lastname: Attar
authors.forename: John P
authors.initials: JP
authors.lastname: Hayes
authors.forename: Terrance
authors.initials: T
authors.lastname: Peabody
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005121:Extremities; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012509:Sarcoma / Q000556:secondary*; D012983:Soft Tissue Neoplasms / Q000473:pathology*; D014481:United States
keywords: lymph node excision; lymphatic metastasis; neoplasms; retrospective studies