A Comparison Study of Staging Systems for Bone Sarcomas

Abstract

A retrospective study of 250 patients treated at one institution was done to evaluate the prognostic significance of the new American Joint Committee on Cancer staging system compared with the Musculoskeletal Tumor Society staging system for patients with sarcomas of bone. Regarding the Musculoskeletal Tumor Society system, there were significant differences in survival among patients with Stage I, Stage II, and Stage III disease. There were no significant differences between patients with Stages I-A and I-B disease, nor between patients with Stages II-A and II-B disease. Similarly, regarding the new American Joint Committee on Cancer staging system, there were significant differences among patients with Stage I, Stage II, and Stage IV disease. No significant differences were seen between patients with Stages I-A and I-B disease, between patients with Stages II-A and II-B disease, nor between patients with Stages IV-A and IV-B disease. A significant advantage in the ability to predict prognosis for one staging system over the other staging system was not shown with the relatively small number of patients in this study.

An examination of the efficacy of the 8 cm maximal tumor diameter cutoff for the subdivision of AJCC stage II osteosarcoma patients

“…We selected 11 previous studies and analyzed them in terms of the distribution of AJCC stage II osteosarcoma patients according to tumor size parameters, and in terms of the prognostic significances of size parameters (Table IV). In these studies using an MTD cutoff 8 cm or a tumor volume cutoff of 150 ml, patients were divided 4:6 (Stage IIA to IIB), and when an MTD cutoff of 9 cm or tumor volume cutoff 200 ml was used patients were divided 5:5 [5,7,[10][11][12]14,15]. These findings are consistent with our results.…”

“…This cutoff fairly evenly divides tumors into the A and B subclassifications of the revised AJCC system. Heck et al [7] retrospectively reviewed 250 patients with a primary malignant bone tumor, and compared the MSTS system with the revised AJCC system. However, they failed to find a significant survival difference between patients with revised AJCC stage IIA and IIB disease.…”

“…However, a staging system should not be based on a treatmentrelated variable, but rather based on initially evaluable parameters, such as, primary tumor size, location, and extent. Several previous studies have assessed the prognostic significance of tumor size in osteosarcoma patients using different parameters, that is, an absolute tumor volume of >60, 150, 200, or 300 ml, an MTD of >8, 9, and 10 cm, and a relative tumor size greater than one-third the length of involved bone [5,7,[8][9][10][11][12][13][14][15][16]. We selected 11 previous studies and analyzed them in terms of the distribution of AJCC stage II osteosarcoma patients according to tumor size parameters, and in terms of the prognostic significances of size parameters (Table IV).…”

Development and external validation of nomograms predicting distant metastases and overall survival after neoadjuvant chemotherapy and surgery for patients with nonmetastatic osteosarcoma: A multi‐institutional study

“…Clinical staging, such as staging using the American Joint Committee on Cancer classification,12 which is based on tumor grade and size, skip metastases, and nodal or distant metastasis at the time of diagnosis is reportedly correlated with survival for patients with bone sarcomas 13. However, in osteosarcoma, other prognostic factors, including patient age,14, 15, 16 tumor location,5, 16 pathologic fracture,17 and responses to preoperative chemotherapy, have been reported to correlate strongly with survival 5, 16, 18.…”

Eficácia do sistema de estadiamento de enneking no tratamento dos tumores ósseos benignos e lesões ósseas pseudotumorais

“…Em levantamento da literatura disponível, observase que esse sistema de estadiamento não foi validado estatisticamente em amplos estudos multicêntricos. Em 2002, a AJCC, que utilizava o Sistema de Enneking, fez modificações no estadiamento de sarcomas, substituindo a localização compartimental pelo tamanho do tumor e dividindo em três categorias os pacientes com metástases skip, metástases pulmonares e outras metástases (25,26) . Os resultados confirmaram que o SEE foi muito eficaz em determinar o prognóstico, planejar a cirurgia e indicar a terapia adjuvante no tratamento dos tumores ósseos benignos e lesões ósseas pseudotumorais (Tabelas 6 e 7).…”