Σταδιοποίηση Σαρκώματος Μαλακών Μορίων

Σάρκωμα Μαλακών Μορίων

AJCC Stages

Stages

T

N

M

G

IA

T1a, T1b

N0

M0

G1, GX

IB

T2a, T2b

N0

M0

G1, GX

IIA

T1a, T1b

N0

M0

G2, G3

IIB

T2a, T2b

N0

M0

G2

III

T2a, T2b

N0

M0

G3

Any T

N1

M0

Any G

IV

Any T

Any N

M1

Any G

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor ≤ 5 cm in greatest dimension

T1a

Superficial tumor ≤ 5 cm in greatest dimension

T1b

Deep tumor ≤ 5 cm in greatest dimension

T2

Tumor > 5 cm in greatest dimension

T2a

Superficial tumor > 5 cm in greatest dimension

T2b

Deep tumor > 5 cm in greatest dimension

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

(G) Histologic Grade

GX

Grade cannot be assessed

G1

Grade 1 (FNCLCC score 2-3)

G2

Grade 2 (FNCLCC score 4-5)

G3

Grade 3 (FNCLCC score 6-8)

Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) is the histologic grading method preferred by AJCC. 
Additional descriptors that can be utilized include residual tumor (R) and combined lymph-vascular invasion (LVI). Residual tumor is coded as cannot be assessed = RX, is not present = R0, is microscopically present = R1, or is macroscopically present = R2. Lymph-vascular invasion is described as not present/not identified, present/identified, not applicable, or unknown/indeterminate.

Χαρακτηριστικά Επέκτασης

• Most common site of metastatic spread is dependent on tumor type
  • Extremity sarcoma = lung
  • Retroperitoneal sarcoma = liver
• Regional involvement of lymph nodes is overall uncommon
• Most common in rhabdomyosarcoma, angiosarcoma, synovial sarcoma, epithelioid sarcoma, & clear cell sarcoma
• Myxoid liposarcoma has predisposition to metastasize to other soft tissue sites
• Iatrogenic spread of tumor to adjacent tissue compartments by poorly planned biopsy or subtotal resection

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• American Joint Committee on Cancer (AJCC) Staging System, 7th edition
  • Unified classification with International Union Against Cancer (UICC) in 1987
  • Based on tumor histologic grade (3-grade system), primary tumor size & depth, and presence of nodal disease and distant metastases
  • Does not take into account anatomic site or whether tumor extends outside compartment of origin
  • Extraskeletal osteosarcoma, extraskeletal Ewing sarcoma, angiosarcoma, dermatofibrosarcoma protuberans, and extraskeletal chondrosarcoma are included in this staging system
  • Not applicable to rhabdomyosarcoma, Kaposi sarcoma, desmoid tumor, mesothelioma, infantile fibrosarcoma, inflammatory myofibroblastic tumor, and gastrointestinal stromal tumor
    • Also not applicable to sarcomas arising from dura matter, brain, parenchymal organs, or hollow viscera
• Surgical Staging System, Musculoskeletal Tumor Society
  • a.k.a. Enneking Staging System
  • Commonly used by orthopedic oncologic surgeons
  • Emphasizes whether tumor is confined to compartment of origin
    • Useful information for surgical planning
    • Has not been proven as predictor of survival
  • Has only 2 histologic grades (low or high)
  • Does not take into account tumor size, tumor location, or nodal status
  • Does not apply to rhabdomyosarcoma or tumors of marrow/reticuloendothelial origin
• Soft Tissue Sarcoma Committee of the Children's Oncology Group (formerly known as Intergroup Rhabdomyosarcoma Study Group)
  • Most used staging system for rhabdomyosarcoma
  • Separates patients into 4 clinical groups based on
    • Complete resection vs. varying degrees of partial resection
    • Extent of tumor beyond muscle or organ of origin
    • Nodal involvement
    • Distant metastases