Quality assessment of lymph node sampling in rhabdomyosarcoma: A surveillance, epidemiology, and end results (SEER) program study

Quality assessment of lymph node sampling in rhabdomyosarcoma: A surveillance, epidemiology, and end results (SEER) program study
Regional lymph node sampling is an important part of management of paratesticular rhabdomyosarcoma (RMS) in boys over 10 years of age and for staging in extremity RMS. This study aimed to determine the compliance of regional lymph node (LN) sampling in a pediatric population with extremity RMS and paratesticular RMS over the age of 10 years.
The retrospective study used SEER registry data for patients in the USA with histologically confirmed RMS who had LN sampling data and age documented (from 2003 to 2008). 537 patients with extremity RMS (aged ≤19 years) and 65 pts with paratesticular RMS (10-19 years) were analysed.
138 of 537 (25.7%) patients with a RMS of the extremities and 31 of 65 (47.7%) had LN sampling done. Lack of LN sampling/excision had a significant impact with decreased patient survival (HR 0.176, p=0.02). Mean follow up was 39 months.
Data excluded patients with missing LN sampling documentation (54% extremity RMS and 59% paratesticular RMS, so difficult to interpret if this is under-reporting or absence of LN sampling. Unable to interpret why sampling was not carried out. No indication on whether procedures were done in pediatric or adult centres. 17 cancer registries were included, so results may not be generalizable.
Lymph node dissection is standard of care in management of patients with paratesticular RMS and this study indicates that there are discrepancies in adherence to surgical guidelines in RMS which could impact survival. Ongoing awareness and education of LN sampling for surgeons and oncologists is needed but results may not be applicable to all pediatric oncology centres.