Analysis of Staging and Management of Patients with Sarcoma

Abstract

Over ten years, 70 patients with soft tissue sarcoma were treated for their primary tumors at the hospital of The Fox Chase Cancer Center. The clinical characteristics of these tumors are correlated with the outcome of various management efforts. The results of these evaluations identify three groups that can provide the basis for future treatment decisions and stratification for randomized studies of management options. The first group of patients, those with small well differentiated tumors, have no systemic spread regardless of the treatment modality used. The second group, those with large (greater than 5 cm) tumors that are moderately or poorly differentiated, do uniformly poorly despite the management techniques used. An intermediate group, those with high grade or large size but not both, have outcomes which may be correlated to treatment modalities.

Modified Staging System for Extremity Soft Tissue Sarcomas

“…Several studies have identified prognostic factors for different end points, such as local recurrence, distant metastasis, and overall survival using multivariate analysis. Various clinicopathological staging systems 29 -31 and prognostic classifications 3,6,7,19,26,32,33 have been proposed in an attempt to correlate clinical and histologic parameters with prognosis and to aid in the selection of patients for adjuvant chemotherapy. The drawbacks of most of these studies have been small cohorts of patients; retrospectively collected data; heterogeneous study populations due to inclusion of patients over a long time period and from multiple institutions with possible differences in treatment philosophy; consideration of recurrent tumors along with primary tumors; and inclusion of sarcomas of different sites with different natural histories.…”

Survival in soft tissue sarcoma: Prognostic variables identified by multivariate analysis

“…This prognostic sex difference is not commonly reported for soft tissue sarcoma when using multivariate analysis (Kindblom et al 1975, Sears et al 1980, Markhede et al 1982, Merck et al 1983. However, Wright et al (1982).…”

“…Merck et al 1983). Other factors that have been found to negatively influence the outcome are high age, large tumor size, central location, pain from the tumor, deep site, male sex, and extracompartmental tumor location (Kindblom et al 1975, Sears et al 1980, Abbas et al 1981, Enneking et al 1980, Wright et al 1982, Merck et al 1983, Rydholm 1983. Recently, extensive tumor necrosis has also been shown to have an adverse effect on prognosis (de Stefani et al 1982, Costa et al 1984, Trojani et al 1984.…”

Prognosis in soft tissue sarcoma

“…Overt metastases when the primary tumor is diagnosed, histologic malignancy grade, tumor necrosis, size, location, depth, sex, and age have all been found to influence prognosis , Russell et al 1977, Hajdu 1979, Enneking et al 1980, Sears et al 1980, Abbas et al 1981, Markhede et al 1982, Wright et al 1982, Merck et al 1983, Costa et al 1984, Angervall et al 1986. Overt metastases when the primary tumor is diagnosed, histologic malignancy grade, tumor necrosis, size, location, depth, sex, and age have all been found to influence prognosis , Russell et al 1977, Hajdu 1979, Enneking et al 1980, Sears et al 1980, Abbas et al 1981, Markhede et al 1982, Wright et al 1982, Merck et al 1983, Costa et al 1984, Angervall et al 1986.…”

“…In group C, the high risk of local recurrence after marginal surgery and the strong association between local recurrence and tumor-related death (Markhede et al 1982, Merck et al 1983) was confirmed. (Kindblom et al 1975, Markhede et al 1982, Merck et al 1983) and large tumor size (Sears et al 1980, Eilber et al 1985 increased the risk of tumor-related death. (Kindblom et al 1975, Markhede et al 1982, Merck et al 1983) and large tumor size (Sears et al 1980, Eilber et al 1985 increased the risk of tumor-related death.…”