Abstract

BackgroundMost staging systems for soft tissue sarcoma are based on histologic malignancy-grade, tumor size and tumor depth. These factors are generally dichotomized, size at 5 cm. We believe it is unlikely that tumor depth per se should influence a tumor's metastatic capability. Therefore we hypothesized that the unfavourable prognostic importance of depth could be explained by the close association between size and depth, deep-seated tumors on average being larger than the superficial ones. When tumor size is dichotomized, this effect should be most pronounced in the large size (>5 cm) group in which the size span is larger.MethodsWe analyzed the associations between tumor size and depth and the prognostic importance of grade, size and depth in a population-based series of 490 adult patients with soft tissue sarcoma of the extremity or trunk wall with complete, 4.5 years minimum, follow-up.ResultsMultivariate analysis showed no major prognostic effect of tumor depth when grade and size were taken into account. The mean size of small tumors was the same whether superficial or deep but the mean size of large and deep-seated tumors were one third larger than that of large but superficial tumors. Tumor depth influenced the prognosis in the subset of high-grade and large tumors. In this subset deep-seated tumors had poorer survival rate than superficial tumors, which could be explained by the larger mean size of the deep-seated tumors.ConclusionMost of the prognostic value of tumor depth in soft tissue sarcomas of the extremity or trunk wall can be explained by the association between tumor size and depth.

Highlights

  • Most staging systems for soft tissue sarcoma are based on histologic malignancy grade, tumor size and tumor depth (the French (FNCLCC) system [1]; the Memorial Sloan Kettering (MSK) system [2]; the American Joint Committee on Cancer/International Union Against Cancer AJCC/ UICC system 5th ed [3]

  • Prognostic factors in total material (Table 3) Multivariate analysis of size, depth, and grade showed size and grade to be of independent prognostic value, irrespective of definition of high grade

  • The largest prognostic study on soft tissue sarcoma hitherto published, based on 2,136 patients treated at the Memorial Sloan-Kettering Cancer Center, showed that both size and depth were of prognostic importance [7]

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Summary

Introduction

Most staging systems for soft tissue sarcoma are based on histologic malignancygrade, tumor size and tumor depth. These factors are generally dichotomized, size at 5 cm. A prognostic effect of tumor depth could be related to size and should be strongest in the large size group in which the size span is greater. We tested this hypothesis in a large populationbased series of soft tissue sarcoma of the extremity and trunk wall in adults

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