Staging of Soft Tissue Sarcoma: What Is New?

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In this issue of the journal, Drs. Lahat, Pollock, and their colleagues from the MD Anderson Cancer Center present ‘‘New perspectives for staging and prognosis in soft tissue sarcoma’’. What is new is in the eyes of the beholder. Ten years ago there was an editorial addressing similar issues. Is 10 years a short time or a long time? In millennia it is of no consequence, in a professional life time it may be 25%. What is clear is that we as a profession are hard to convince and slow to change. It has long been known that staging of soft tissue sarcoma is not a precise science. Early attempts to divide staging by grade and size resulted in small, less than 5 cm, high-grade lesions being included in stage III with a 5-year survival of approximately 20%. This was recognized and subsequently changed, and depth as superficial or deep incorporated. Unfortunately, large high-grade superficial tumors are rare and distort the staging system. This was recognized and it was suggested that size be further characterized into 10 cm ranges. This is addressed in the Lahat manuscript, identifying that size differentiation can be improved by categorizing size as 15 cm. What may be new is the ‘‘confirmation’’ that a twograde system described more than 20 years ago is as precise as our imprecision can get! The inapplicability of conventional staging to other than extremity lesions is also confirmed. Attempts at characterizing individual outcomes by site utilizing nomograms have been developed. Attempts to improve nomograms by utilizing siteor histology-specific nomograms has been a further important but incomplete development. As the present authors point out, local recurrence is an important risk factor for sarcoma-specific survival, as described earlier by one of the co-authors. Additional nomograms looking at survival following local recurrence have been developed, emphasizing the importance of the time variability of most prognostic factors, and offer some prospects for better prognostication. The present contribution by Dr. Pollock and his colleagues reinforces observations that have been made in the past. Once again, it seems we have the information but we move awfully slowly in utilizing it for patient care and management.