title: Quality assessment of lymph node sampling in rhabdomyosarcoma: A surveillance, epidemiology, and end results (SEER) program study.
abstract: BACKGROUND
  Lymph node sampling is integral in the management of extremity and paratesticular rhabdomyosarcoma (RMS). The aim of this study was to determine overall surgical compliance with treatment protocols and impact of nodal sampling outcomes in these tumors.
  
  
  METHODS
  A query of the surveillance, epidemiology, and end results program (SEER) database was performed from 2003 to 2008 for patients <19years of age with RMS. Data obtained included demographics, five-year survival and rate of nodal sampling. Analysis was performed utilizing chi-squared, Kaplan-Meier and hazard ratio modeling.
  
  
  RESULTS
  Of 537 patients with extremity RMS, nodal sampling was performed in 25.7% (n=138). This lack of nodal sampling had a negative outcome on survival (p=0.004). Sixty five patients with paratesticular RMS aged greater than 10 were identified and also displayed low rates of lymph node sampling (47.7%, n=31). For paratesticular patients, a similar increase in survival was seen in patients who underwent nodal evaluation (p=0.024).
  
  
  CONCLUSIONS
  Lymph node sampling is the standard of care in RMS. However, surgical compliance with treatment protocols is poor. Nodal evaluation correlated significantly with overall survival. These findings suggest a need for improved education among surgeons and oncologists regarding the need lymph node assessment in pediatric oncology patients. Evidence rating/classification: Prognosis study, Level III.
authors.affiliation: Division of General and Thoracic Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Inna
authors.initials: I
authors.lastname: Lobeck
authors.affiliation: Division of General and Thoracic Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Phylicia
authors.initials: P
authors.lastname: Dupree
authors.affiliation: Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Karns
authors.affiliation: Division of Pediatric Surgery, East Carolina University, Greenville, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rodeberg
authors.affiliation: Division of General and Thoracic Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: von Allmen
authors.affiliation: Division of General and Thoracic Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: Roshni.Dasgupta@cchmc.org.
authors.forename: Roshni
authors.initials: R
authors.lastname: Dasgupta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008197:Lymph Node Excision / Q000592:standards / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018426:SEER Program; D016019:Survival Analysis; D013737:Testis; D014481:United States
keywords: Extremity rhabdomyosarcoma; Lymph node sampling; Paratesticular rhabdomyosarcoma; Pediatric solid tumor; Rhabdomyosarcoma