Impact of Nodal Metastasis on Survival in Clear Cell Sarcoma

Abstract

Aim: Clear Cell Sarcoma (CCS) of soft tissue is a high-grade malignancy that often occurs on the distal extremities. The five-year overall survival is reported to be around 40%. Lymph node metastasis, that is categorized into stage IV in the latest American Joint Committee on Cancer (AJCC, 8th edition) staging system, is characteristic in CCS. We here focused on the impact of nodal metastasis on prognosis in CCS. Methods: We performed a retrospective analysis of 37 patients with CCS who were treated between 1982 and 2023. This study investigated age, gender, tumor size, tumor location, AJCC stage (7th and 8th edition), presence of lymph node or distant metastasis, presence of surgery, chemotherapy, radiotherapy, and surgical margin. Statistical analysis was conducted to evaluate the impact of each factor on survival. Results: In our cohort, tumor location, tumor size, and stage were significant prognostic factors. Notably, the disease-Specific Survival (DSS) in patients with nodal and/or distant metastasis was significantly shorter than those with no metastasis while DSS in the patients with nodal metastasis was not significantly different from those with distant metastasis. Conclusion: Consistent with the latest AJCC 8th edition in which nodal and distant metastasis are both categorized into stage IV, there was no difference in DDS between nodal metastasis and distant metastasis in CCS in the present study. This result highlights the importance of nodal metastasis in CCS.