1/9/2024 0 Comments Engauge digitizer onlineAs such, this system indeed fulfills the criterion of simplicity, perhaps even more than prior systems, but, as all others, lacks a personalized view and it lumps prediction only based upon dichotomized size and grade, but not upon subtype, depth of tumor location, and both age and size as continuous variables. The authors concluded that their proposed staging system maintained prognostic significance between stages though being a simplified system and, finally, that for high-grade tumors, a cutoff of 7.5 cm, instead of 5 cm, maintained discrimination for survival and could be a more clinically applicable cutoff for future clinical trials. The only difference in the new proposed system is a cut-off at 7.5 cm to be lumped into stage II or, if larger than 7.5 cm into stage III. The major difference among the three systems lies in the fact that the AJCC 8th edition dissects all non-metastatic high-grade tumors into ≤5 cm to stage II, 5–10 cm to stage IIIA and ≥10 cm as stage IIIB. In all three systems, metastatic disease is categorized to stage IV. In all three systems, among stage I cases are patients with non-metastasized low-grade tumors, where the AJCC systems further subdivide into suffix A and B on a cut-off of 5 cm. In stage IV patients are diagnosed with any kind of metastases regardless of grade or size.Īuthors have compared their patient outcomes to the American Joint Committee on Cancer (AJCC) staging systems, edition 7 and 8 ( 2, 3). Among stage II and III are patients with high grade tumors without any metastases the dichotomy is on a size cut-off set at 7.5 cm. Stage I is designated for all low-grade sarcomas regardless of size as long as they are not metastasized. In their proposed new staging system, all intermediate and high-grade tumors are lumped into the category of high grade. Patients with desmoid tumors, uterine sarcomas, and those who underwent R2 resection or died within 30 days of their operation were excluded as well as those histological subtypes that, by definition, should not be graded. They used their Sarcoma Collaborative database compiling results form 1,318 patients resected with curative intent between 20 across 7 tertiary referral centers. Recently, Johnson and co-workers have published a very interesting and easy novel staging system in the Journal of Surgical Oncology ( 1). This simplicity obviously harbors pitfalls it disregards cytogenetic and molecular-biological predictive factors across tumors of the same size. Hereto, for instance for many carcinomas, a T1 is 5 cm, a T2 in between and a T4 with ingrowth into neighboring organs. Clinicians should preferably be able to remember the definitions by heart, without the need to consult elaborate books or websites. to be able to compare outcome parameters between different hospitals įor most (epithelial) malignancies, the so-called TNM nomenclature described diseases with respect to tumor size (T) and the presence of nodal (N) and/or hematogenous (M) metastases.ĭaily clinical applicability of such systems and their use are dependent upon simplicity.to speak the same language across the globe.Throughout oncology, the three most important (but not only) reasons to propose staging systems are: A novel, simplified, externally validated staging system for truncal/extremity soft tissue sarcomas: An analysis of the US Sarcoma Collaborative database. Email: on: Johnson AC, Ethun CG, Liu Y, et al. Department of Radiotherapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. Interviews with Outstanding Guest EditorsĬorrespondence to: Rick L. Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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