Fukuma H, Beppu Y, Yokoyama R, Omiya K
Dept. of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Gan To Kagaku Ryoho. 1997 Jun;24(8):1035-40.
TNM classification of bone and soft tissue sarcomas was published by UICC in 1987. Histological grading (G) is an important factor in this classification, but the criteria of G categories are not so clear. In addition, lymph node metastasis is very rare in bone and soft tissue sarcoma. Therefore, prognostic factors are limited to T, M and G categories. Since correlation between the stage (UICC) and the survival rate was not found in patients with osteosarcoma, TNM classification (UICC) has not been used widely in the field of orthopedic oncology. The Musculoskeletal Tumor Committee of the Japanese Orthopaedic Association proposed another TNM classification of osteosarcoma based on multivariate analysis. T1 is less than 15 cm and T2 is 15 cm or larger in maximal diameter. N and M are same with the UICC criteria. Serum alkaline phosphatase level (A) is included in this classification in which A0 is less than the normal value x2.5, and A1 is the normal value x2.5 or more. G categories are separated into two groups according to the mitotic rate in a high power field (x200); G1 is assigned to the tumor with 0-9/1 HPF and G2 is assigned to those with 10 or more/1 HPF. Reclassification of osteosar-coma by this modified TNM system indicated that there was a correlation between the survival rate and the stage.
国际抗癌联盟（UICC）于1987年发布了骨与软组织肉瘤的TNM分类。组织学分级（G）是该分类中的一个重要因素，但G类别的标准并不十分明确。此外，骨与软组织肉瘤中淋巴结转移非常罕见。因此，预后因素仅限于T、M和G类别。由于在骨肉瘤患者中未发现分期（UICC）与生存率之间的相关性，TNM分类（UICC）在骨肿瘤学领域并未得到广泛应用。日本骨科学会肌肉骨骼肿瘤委员会基于多变量分析提出了另一种骨肉瘤的TNM分类。T1为最大直径小于15 cm，T2为最大直径15 cm或更大。N和M与UICC标准相同。该分类纳入了血清碱性磷酸酶水平（A），其中A0小于正常值的2.5倍，A1为正常值的2.5倍或更高。G类别根据高倍视野（×200）中的有丝分裂率分为两组；G1分配给每高倍视野有0 - 9个有丝分裂象的肿瘤，G2分配给每高倍视野有10个或更多有丝分裂象的肿瘤。通过这种改良的TNM系统对骨肉瘤进行重新分类表明，生存率与分期之间存在相关性。
