Lawrence W, Gehan E A, Hays D M, Beltangady M, Maurer H M
J Clin Oncol. 1987 Jan;5(1):46-54. doi: 10.1200/JCO.1987.5.1.46.
The need for a pretreatment staging system to accurately assess programs of therapy for the various sites and stages of childhood rhabdomyosarcoma has become apparent as detailed analyses of many factors affecting prognosis and treatment choices have been accomplished through the national cooperative trial, the Intergroup Rhabdomyosarcoma Study (IRS). Initiated in 1972, the IRS has thus far used a clinicopathologic grouping system that is based heavily on therapeutic decisions, particularly on whether or not excision is accomplished and the extent of such an operation. The major problem with this and several other staging classifications now in use is that they depend on pathologic data obtained after surgical treatment has been initiated or rejected. In addition, they do not consider histologic variations of this neoplasm which may be important in estimating prognosis. The large body of clinical data now accumulated in the IRS has provided an excellent opportunity for developing a database for evaluating the International Union Against Cancer (UICC) pretreatment staging system and also the potential for using histologic categories in the staging process. The records of 505 eligible patients entered into the IRS between 1978 and 1982 were used to determine the prognostic impact of a number of pretreatment factors. These included local invasiveness of the primary neoplasm on clinical examination, tumor size, clinical status of regional nodes, clinical or radiologic evidence of distant metastases, and favorable or unfavorable histologic categories. A retrospective assessment of the relationship of these pretreatment observations to survival experience has been carried out. This retrospective study indicates definite prognostic significance for all of the individual factors used on the UICC system except clinical status of regional nodes. Also, these data serve as a basis for considering the possibility of including favorable v unfavorable histology in the pretreatment staging system now being tested prospectively in the ongoing IRS protocols.
随着通过全国性合作试验——横纹肌肉瘤研究组（IRS）对许多影响预后和治疗选择的因素进行了详细分析，对于一种预处理分期系统以准确评估儿童横纹肌肉瘤不同部位和阶段的治疗方案的需求变得明显起来。IRS始于1972年，迄今为止使用的是一种临床病理分组系统，该系统在很大程度上基于治疗决策，特别是基于是否完成切除以及该手术的范围。目前正在使用的这一系统以及其他几种分期分类的主要问题在于，它们依赖于在手术治疗开始或被拒绝后获得的病理数据。此外，它们没有考虑到这种肿瘤的组织学变异，而这在估计预后方面可能很重要。IRS目前积累的大量临床数据为开发一个数据库以评估国际抗癌联盟（UICC）的预处理分期系统以及在分期过程中使用组织学分类的可能性提供了绝佳机会。1978年至1982年间进入IRS的505例符合条件患者的记录被用于确定一些预处理因素的预后影响。这些因素包括临床检查中原发性肿瘤的局部侵袭性、肿瘤大小、区域淋巴结的临床状态、远处转移的临床或放射学证据以及有利或不利的组织学分类。已经对这些预处理观察结果与生存经验之间的关系进行了回顾性评估。这项回顾性研究表明，除区域淋巴结的临床状态外，UICC系统所使用的所有个体因素都具有明确的预后意义。此外，这些数据为考虑在目前正在IRS现行方案中进行前瞻性测试的预处理分期系统中纳入有利与不利组织学的可能性提供了依据。
