Prognostic significance of grading and staging systems using MIB‐1 score in adult patients with soft tissue sarcoma of the extremities and trunk

Abstract

BACKGROUND The predictive value of histologic grading and staging systems for overall survival in different types of adult soft tissue sarcoma of the extremities and trunk is unclear. METHODS Histologic slides from 193 patients with primary tumors were reviewed for diagnosis, and Ki‐67 (MIB‐1) immunostaining was performed for grading in all patients. Univariate and multivariate analyses were conducted to analyze the results from patients with soft tissue sarcomas as a group and among the six main histologic categories: malignant fibrous histiocytoma (n = 49 patients), liposarcoma (n = 48 patients), synovial sarcoma (n = 30 patients), spindle cell sarcoma (n = 24 patients), small round cell sarcoma (n = 15 patients), and others (n = 27 patients). The median follow‐up was 50 months. RESULTS Univariate analysis of soft tissue sarcomas showed that tumor size and depth, histologic type, MIB‐1 score, grades based on three criteria (tumor differentiation/histologic type, necrosis, and either mitosis or MIB‐1 score) and disease stage, as assessed by tumor size, depth, and grade, were associated with overall survival. Among these variables, grading and staging systems using the MIB‐1 score had better predictive value compared with the MIB‐1 score and standard grading and staging models in the main histologic categories. Because survival curves for the different tumor grades and stages showed similar trends between the different histologic types, multivariate analysis was conducted adjusting for age, gender, disease site, surgical margin, tumor size and depth, grade, stage, and histologic type. Consequently, Grade 3 emerged as the most significant adverse prognostic factor. Additional adverse prognostic factors were Stage III, Grade 2, a histologic type of spindle cell sarcoma, and patient age > 50 years at the time of presentation. The histologic type liposarcoma was identified as a favorable prognostic factor. CONCLUSIONS The current results indicate that grading and staging systems using the MIB‐1 score are very strong prognostic factors in patients with the main histologic types of soft tissue sarcoma. Specific assessment of histologic type should be carried out before deciding on treatment strategies. Cancer 2002;95:843–51. © 2002 American Cancer Society. DOI 10.1002/cncr.10728

Prognostic significance of Minichromosome maintenance protein 7 and Geminin expression in patients with 109 soft tissue sarcomas

“…A Ki-67 LI was correlated with the poor prognosis of patients with several malignancies (28,34,43). Ki-67 has been used as a common and valuable prognostic marker in STSs (8,9,44,45). We also showed that MCM7 and Geminin LIs are positively correlated with Ki-67 LIs.…”

“…Ki-67 was present throughout the complete cell cycle, except for the early G1 phase, which is associated with poor prognosis of the disease (43)(44)(45). A Ki-67 LI was correlated with the poor prognosis of patients with several malignancies (28,34,43).…”

Synovial sarcoma

“…21 Nonetheless, it is not simple to conduct prospective and randomized studies, because of the rarity of each entity. In this perspective, a retrospective analysis represents a useful tool with which to define prognostic factors and the best treatment strategy, accepting the drawbacks of this kind of study design.…”

Primary pulmonary and mediastinal synovial sarcoma: a clinicopathologic study of 60 cases and comparison with five prior series

“…Interobserver variability in application of tumor grading criteria can be virtually eliminated by use of the reproducible FNCLCC grading scheme, which has prognostic value. 22 Errors in the histological subtyping of primary pulmonary and mediastinal synovial sarcoma can occur when entrapped pneumocytes are misinterpreted as the epithelial component of biphasic tumors. Entrapped pneumocytes are cytologically benign, are typically arranged in small clusters and/ or well-formed gland-like structures at the periphery of the tumor (Figure 3e), and are immunoreactive with thyroid transcription factor-1 (Figure 3f).…”