Maki, R. G., Moraco, N., Antonescu, C. R., Hameed, M., Pinkhasik, A., Singer, S., Brennan, M. F. (October 2013) Toward better soft tissue sarcoma staging: building on american joint committee on cancer staging systems versions 6 and 7. Ann Surg Oncol, 20 (11). pp. 3377-83. ISSN 1534-4681 (Electronic)1068-9265 (Linking)
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.
| Item Type: | Paper |
|---|---|
| Uncontrolled Keywords: | Combined Modality Therapy Female Follow-Up Studies Humans Lymphatic Metastasis Male Middle Aged Neoplasm Recurrence, Local/classification/*pathology/therapy Neoplasm Staging Prognosis Prospective Studies Sarcoma/classification/*pathology/therapy Survival Rate |
| Subjects: | diseases & disorders > cancer > prognosis diseases & disorders > cancer > cancer types > sarcoma |
| CSHL Authors: | |
| Communities: | CSHL labs > Maki lab |
| Depositing User: | Matt Covey |
| Date: | October 2013 |
| Date Deposited: | 20 Oct 2016 15:33 |
| Last Modified: | 20 Oct 2016 15:33 |
| PMCID: | PMC4067483 |
| Related URLs: | |
| URI: | https://repository.cshl.edu/id/eprint/33756 |
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