A prognostic model for soft tissue sarcoma of the extremities and trunk wall based on size, vascular invasion, necrosis, and growth pattern

Abstract

BACKGROUND:In soft tissue sarcoma, better distinction of high-risk and low-risk patients is needed to individualize treatment and improve survival. Prognostic systems used in clinical practice identify high-risk patients based on various factors, including age, tumor size and depth, histological type, necrosis, and grade. METHODS: Whole-tumor sections from 239 soft tissue sarcomas of the extremities were reviewed for the following prognostic factors: size, vascular invasion, necrosis, and growth pattern. A new prognostic model, referred to as SING (Size, Invasion, Necrosis, Growth), was established and compared with other clinically applied systems. RESULTS: Size, vascular invasion, necrosis, and peripheral tumor growth pattern provided independent prognostic information with hazard ratios of 2.2-2.6 for development of metastases in multivariate analysis. When these factors were combined into the prognostic model SING, high risk of metastasis was predicted with a sensitivity of 74% and a specificity of 85%. Moreover, the prognostic performance of SING compared favorably with other widely used systems. CONCLUSIONS: SING represents a promising prognostic model, and vascular invasion and tumor growth pattern should be considered in soft tissue sarcoma prognostication.

Ezrin expression predicts local recurrence and development of metastases in soft tissue sarcomas

“…We have recently identified infiltrative tumour growth pattern as a predictor of local and distant tumour recurrences in STS 28 39 40. The present work provides yet another validation of the prognostic importance of growth pattern, but also identifies a correlation between infiltrative growth pattern and ezrin expression (OR=3.1, p=0.03).…”

The Prognostic Value of Histological Tumor Necrosis in Solid Organ Malignant Disease: A Systematic Review

“…This was confirmed in subsequent studies and led to the inclusion of necrosis in a four point prognostic model for sarcoma [58,59].…”

Prognostic significance of histological invasion in high grade soft tissue sarcomas

“…Numerous studies have identified clinical prognostic factors that could influence survival and local recurrence of soft tissue sarcoma (Behranwala et al 2004; Carneiro et al 2011; Coindre et al 1996; Collin et al 1987; Eilber et al 2004; Eilber et al 2003; Gaynor et al 1992; Heise et al 1986; Kattan et al 2002; Lahat et al 2008; McKee et al 2004; Mutter et al 2012; Pisters et al 1996; Ramanathan et al 1999; Riad et al 2004; Rööser et al 1988; Singer et al 1994; Stefanovski et al 2002; Stojadinovic et al 2002; Stotter et al 1990; Trojani et al 1984; Ueda et al 1988; Zagars et al 2003). Soft tissue sarcomas are characterized by aggressive histological invasiveness, which has been correlated with their prognosis (Gustafson et al 2003; Carneiro et al 2011). Almost all high grade sarcomas show histological extracapsular invasion.…”