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Trends of lymph node sampling and metastasis in pediatric patients with clear cell, epithelioid, and synovial sarcomas
  • +4
  • Jennine Weller,
  • Carly Westermann,
  • Palak Patel,
  • Ross Beckman,
  • Christine Pratilas,
  • Carol Morris,
  • Daniel Rhee
Jennine Weller
Johns Hopkins School of Medicine
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Carly Westermann
Johns Hopkins University School of Medicine
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Palak Patel
Johns Hopkins University School of Medicine
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Ross Beckman
Johns Hopkins University School of Medicine
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Christine Pratilas
John Hopkins
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Carol Morris
The Johns Hopkins University
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Daniel Rhee
Johns Hopkins School of Medicine
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Background: Clear cell sarcoma (CCS), epithelioid sarcoma, and synovial sarcoma are rare tumors historically identified as high risk for lymph node metastasis. Nodal metastasis in adults with these subtypes has been described. This study investigates incident nodal metastasis and associated survival in children with these subtypes. Procedure: Using the National Cancer Database (2004-2015), we created a retrospective cohort of 1303 patients (aged ≤25 years) who underwent local control therapy for CCS, epithelioid sarcoma, and synovial sarcoma. Kaplan-Meier curves estimated overall survival (OS) by subtype. Stratifying on subtype, Cox regressions assessed OS by lymph node sampling status and nodal metastasis. Results: There were 103 (7.9%) patients with CCS, 221 (17.0%) with epithelioid sarcoma, and 979 (75.1%) with synovial sarcoma. Lymph node sampling was more frequent in patients with CCS (56.3%) and epithelioid sarcoma (52.5%) versus synovial sarcoma (20.5%, p<0.001). Synovial sarcoma metastasized to lymph nodes less frequently than CCS or epithelioid sarcoma (2.2% vs. 14.6% and 15.0%, p<0.001). Across all subtypes, lymph node metastasis was associated with inferior OS (HR 2.10, CI 1.44-3.07, p<0.001). Lymph node sampling was associated with improved OS in CCS (HR 0.35, CI 0.15-0.78, p=0.010), inferior OS in synovial sarcoma (HR 1.60, CI 1.13- 2.25, p=0.007), and no statistical association with OS in epithelioid sarcoma. Conclusions: Lymph node metastasis is rare in children with synovial sarcoma. Lymph node sampling procedures were not consistently performed for patients with CCS or epithelioid sarcoma, but improved OS supports routine lymph node sampling in children with CCS.

Peer review status:IN REVISION

12 Jun 2021Assigned to Editor
12 Jun 2021Submission Checks Completed
12 Jun 2021Submitted to Pediatric Blood & Cancer
23 Jun 2021Reviewer(s) Assigned
30 Jun 2021Review(s) Completed, Editorial Evaluation Pending
02 Jul 2021Editorial Decision: Revise Minor