Annals of Surgical Oncology

, Volume 11, Issue 5, pp 483–490

Evaluation of a Clinically Applicable Post-Surgical Classification System for Primary Retroperitoneal Soft-Tissue Sarcoma

  • Thijs van Dalen
  • Adriaan Hennipman
  • Frits van Coevorden
  • Harald J. Hoekstra
  • Bert N. van Geel
  • Piet Slootweg
  • Cherry F. Albus Lutter
  • Murray F. Brennan
  • Samuel Singer
Original Articles
  • 143 Downloads

Abstract

Background: The present AJCC/TNM staging system is of limited value for prediction of prognosis for patients with retroperitoneal sarcoma. The objective of the present study was to develop a postsurgical classification system that would enable comparison of outcomes for patients with primary retroperitoneal soft-tissue sarcoma.

Methods: Four classes were defined: I, low-grade/complete resection/no metastasis; II, high-grade/complete resection/no metastasis; III, any-grade/incomplete resection/no metastasis; and IV, any-grade/any resection/distant metastasis. The prognostic value of this classification system was analyzed in a population-based multicenter group(MCG) of patients with primary retroperitoneal soft-tissue sarcoma (n = 124) and in a cohort of patients treated in a single tertiary referral center (SCG; n = 107).

Results: Overall 5-year survival rates were 55% in the SCG and 43% in the MCG (P = 0.02). Class III (incomplete resection) was more frequent in the MCG than in the SCG (33% vs. 16%; P = 0.02). In the SCG, stage-specific 5-year survival rates were 89%, 40%, 26%, and 17% for classes I, II, III, and IV, respectively (P < 0.001), in comparison with 68%, 46%, 24%, and 0% in the MCG (P < 0.001). In a comparison of class-specific survival between the groups, only class I patients in the SCG had significantly better survival than class I patients in the MCG (P = 0.048).

Conclusions: Classification based on grade, completeness of resection, and distant metastasis offers a reproducible prognostic tool that can be used to evaluate treatment strategies for primary retroperitoneal soft-tissue sarcoma. The probability of complete resection was significantly higher in the SCG than in the MCG. In patients with low-grade, completely resected sarcoma, there is a significant survival benefit with treatment in a high-volume tertiary center of excellence.

Key Words

Classification Outcomes Prognostic factors Retroperitoneal Sarcoma 

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Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • Thijs van Dalen
    • 1
  • Adriaan Hennipman
    • 1
  • Frits van Coevorden
    • 1
  • Harald J. Hoekstra
    • 1
  • Bert N. van Geel
    • 1
  • Piet Slootweg
    • 1
  • Cherry F. Albus Lutter
    • 1
  • Murray F. Brennan
    • 2
  • Samuel Singer
    • 2
    • 3
  1. 1.Dutch Soft Tissue Sarcoma GroupVereniging van Integrale Kanker CentraUtrechtThe Netherlands
  2. 2.Sarcoma Disease Management TeamDepartment of Surgery, Memorial Sloan-Kettering Cancer CenterNew York, NY
  3. 3.Memorial Sloan-Kettering Cancer CenterDepartment Of SurgeryNew York, NY

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