Toward better soft tissue sarcoma staging: building on american joint committee on cancer staging systems versions 6 and 7.

Abstract:

BACKGROUND:Based on review of patient data in case conferences over time, we hypothesized that clinically relevant data are omitted in routine soft tissue sarcoma staging. METHODS:We examined subsets of a prospectively collected single institution soft tissue sarcoma database with respect to criteria of the AJCC versions 6 (2002) and 7 (2010) staging systems and examined their clinical outcomes. RESULTS:Relapse-free survival decreases with increasing primary tumor size in four categories, versus two categories used in AJCC 6 and 7 staging. Disease-specific survival decreases over three categories. Conversely, omission of tumor depth as a prognostic factor in version 7 appears supported, since tumor depth is not an independent risk factor for disease-specific survival by multivariate analysis. Patients with nodal disease and no other metastases fare better than patients with other metastases, but have inferior outcomes compared with patients with large high-grade tumors without nodal metastasis. Multivariate analysis identified size, site, grade, age, nodal metastatic disease, and other metastatic disease as independent risk factors for disease-specific survival. Versions 6 and 7 criteria are tacit regarding anatomic site and histology for tumors with identical FNCLCC grade. CONCLUSIONS:Improved patient risk assessment may be achieved by staging using a larger number of size categories. Staging system refinements come at the cost of a larger number of staging categories. Histology or site-specific staging systems, nomograms or Bayesian belief networks may provide more accurate means to assess clinical outcomes.

journal_name

Ann Surg Oncol

authors

Maki RG,Moraco N,Antonescu CR,Hameed M,Pinkhasik A,Singer S,Brennan MF

doi

10.1245/s10434-013-3052-0

subject

Has Abstract

pub_date

2013-10-01 00:00:00

pages

3377-83

issue

11

eissn

1068-9265

issn

1534-4681

journal_volume

20

pub_type

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