van Dalen Thijs, Hennipman Adriaan, Van Coevorden Frits, Hoekstra Harald J, van Geel Bert N, Slootweg Piet, Lutter Cherry F Albus, Brennan Murray F, Singer Samuel
Dutch Soft Tissue Sarcoma Group, Vereniging van Integrale Kanker Centra, Utrecht, The Netherlands.
Ann Surg Oncol. 2004 May;11(5):483-90. doi: 10.1245/ASO.2004.09.005. Epub 2004 Apr 12.
The present AJCC/TNM staging system is of limited value for prediction of prognosis for patients with retroperitoneal sarcoma. The objective of the present study was to develop a postsurgical classification system that would enable comparison of outcomes for patients with primary retroperitoneal soft-tissue sarcoma.
Four classes were defined: I, low-grade/complete resection/no metastasis; II, high-grade/complete resection/no metastasis; III, any-grade/incomplete resection/no metastasis; and IV, any-grade/any resection/distant metastasis. The prognostic value of this classification system was analyzed in a population-based multicenter group(MCG) of patients with primary retroperitoneal soft-tissue sarcoma (n = 124) and in a cohort of patients treated in a single tertiary referral center (SCG; n = 107).
Overall 5-year survival rates were 55% in the SCG and 43% in the MCG (P = 0.02). Class III (incomplete resection) was more frequent in the MCG than in the SCG (33% vs. 16%; P = 0.02). In the SCG, stage-specific 5-year survival rates were 89%, 40%, 26%, and 17% for classes I, II, III, and IV, respectively (P < 0.001), in comparison with 68%, 46%, 24%, and 0% in the MCG (P < 0.001). In a comparison of class-specific survival between the groups, only class I patients in the SCG had significantly better survival than class I patients in the MCG (P = 0.048).
Classification based on grade, completeness of resection, and distant metastasis offers a reproducible prognostic tool that can be used to evaluate treatment strategies for primary retroperitoneal soft-tissue sarcoma. The probability of complete resection was significantly higher in the SCG than in the MCG. In patients with low-grade, completely resected sarcoma, there is a significant survival benefit with treatment in a high-volume tertiary center of excellence.
目前的美国癌症联合委员会（AJCC）/国际抗癌联盟（TNM）分期系统在预测腹膜后肉瘤患者的预后方面价值有限。本研究的目的是开发一种术后分类系统，以便能够比较原发性腹膜后软组织肉瘤患者的治疗结果。
定义了四类：I类，低级别/完整切除/无转移；II类，高级别/完整切除/无转移；III类，任何级别/不完全切除/无转移；IV类，任何级别/任何切除/远处转移。在一个基于人群的多中心组（MCG）的原发性腹膜后软组织肉瘤患者（n = 124）和一个在单一三级转诊中心治疗的队列患者（SCG；n = 107）中分析了该分类系统的预后价值。
SCG的总体5年生存率为55%，MCG为43%（P = 0.02）。III类（不完全切除）在MCG中比在SCG中更常见（33%对16%；P = 0.02）。在SCG中，I、II、III和IV类的特定阶段5年生存率分别为89%、40%、26%和17%（P < 0.001），而在MCG中分别为68%、46%、24%和0%（P < 0.001）。在比较两组之间特定类别的生存率时，只有SCG中的I类患者的生存率明显高于MCG中的I类患者（P = 0.048）。
基于分级、切除完整性和远处转移的分类提供了一种可重复的预后工具，可用于评估原发性腹膜后软组织肉瘤的治疗策略。SCG中完整切除的概率明显高于MCG。在低级别、完全切除的肉瘤患者中，在大容量的三级卓越中心接受治疗有显著的生存益处。
