Lahat G, Tuvin D, Wei C, Anaya D A, Bekele B N, Lazar A J, Pisters P W, Lev D, Pollock R E
Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe St., Unit 1104, Houston, TX, 77030, USA.
Ann Surg Oncol. 2008 Oct;15(10):2739-48. doi: 10.1245/s10434-008-9970-6. Epub 2008 Jun 3.
Data suggest that the current American Joint Committee on Cancer (AJCC) soft tissue sarcoma (STS) staging criteria merit further evaluation. We sought to identify and validate factors as enhanced descriptors of STS clinical behavior.
Prospectively accrued data were analyzed for 1,091 AJCC stage I to III primary STS patients who had complete macroscopic resection at our institution from 1996 to 2007. Study factors were examined by univariable and multivariable analyses to identify independent prognostic factors for disease related mortality and overall survival (OS).
In contrast to the current AJCC STS staging system, which stratifies size into T1 (</=5 cm) and T2 (>5 cm) groups, we demonstrated three distinct cohorts (P < 0.0001): T1 (</=5 cm; 5-year OS 85%), T2 (5 to 15 cm; OS 68%), and T3 (>15 cm; OS 52%). A two-category system of histologic grade was demonstrably as informative as the current four histologic grade AJCC system. A multivariable Cox proportional hazard model identified tumor size (5 to 15 cm vs. </=5 cm, P = 0.03; or >15 cm vs. </=5 cm; P < 0.0001), nonextremity primary site (P = 0.0016), disease of high histologic grade (P = 0.001), specific histology (P = 0.001), and margin positivity (P < 0.0001) as statistically significant adverse independent prognostic factors. Recurrence during follow-up was the most significant risk factor for STS-specific mortality (P < 0.0001).
Tumor size and grade in the AJCC STS staging system need revision; moreover, primary site, histologic subtype, margin status, and recurrence offer additional relevant prognostic insight. Incorporation of these factors may enhance the AJCC staging system, thereby further facilitating individualized therapeutic strategies for STS patients.
数据表明，当前美国癌症联合委员会（AJCC）的软组织肉瘤（STS）分期标准值得进一步评估。我们试图确定并验证一些因素，作为STS临床行为的强化描述指标。
对1996年至2007年在本机构接受完整宏观切除的1091例AJCC I至III期原发性STS患者的前瞻性累积数据进行分析。通过单变量和多变量分析研究各因素，以确定疾病相关死亡率和总生存期（OS）的独立预后因素。
与当前将肿瘤大小分为T1（≤5 cm）和T2（>5 cm）组的AJCC STS分期系统不同，我们发现了三个不同的队列（P < 0.0001）：T1（≤5 cm；5年OS为85%）、T2（5至15 cm；OS为68%）和T3（>15 cm；OS为52%）。一个两级组织学分级系统与当前的四级AJCC组织学分级系统一样具有信息价值。多变量Cox比例风险模型确定肿瘤大小（5至15 cm 对比 ≤5 cm，P = 0.03；或>15 cm对比≤5 cm；P < 0.0001）、非肢体原发部位（P = 0.0016）、高组织学分级疾病（P = 0.001）、特定组织学类型（P = 0.001）和切缘阳性（P < 0.0001）为具有统计学意义的不良独立预后因素。随访期间复发是STS特异性死亡的最显著危险因素（P < 0.0001）。
AJCC STS分期系统中的肿瘤大小和分级需要修订；此外，原发部位、组织学亚型、切缘状态和复发提供了额外的相关预后信息。纳入这些因素可能会改进AJCC分期系统，从而进一步促进针对STS患者的个体化治疗策略。
