Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3377–3383 | Cite as

Toward Better Soft Tissue Sarcoma Staging: Building on American Joint Committee on Cancer Staging Systems Versions 6 and 7

  • Robert G. MakiEmail author
  • Nicole Moraco
  • Cristina R. Antonescu
  • Meera Hameed
  • Alisa Pinkhasik
  • Samuel Singer
  • Murray F. Brennan
Bone and Soft Tissue Sarcomas



Based on review of patient data in case conferences over time, we hypothesized that clinically relevant data are omitted in routine soft tissue sarcoma staging.


We examined subsets of a prospectively collected single institution soft tissue sarcoma database with respect to criteria of the AJCC versions 6 (2002) and 7 (2010) staging systems and examined their clinical outcomes.


Relapse-free survival decreases with increasing primary tumor size in four categories, versus two categories used in AJCC 6 and 7 staging. Disease-specific survival decreases over three categories. Conversely, omission of tumor depth as a prognostic factor in version 7 appears supported, since tumor depth is not an independent risk factor for disease-specific survival by multivariate analysis. Patients with nodal disease and no other metastases fare better than patients with other metastases, but have inferior outcomes compared with patients with large high-grade tumors without nodal metastasis. Multivariate analysis identified size, site, grade, age, nodal metastatic disease, and other metastatic disease as independent risk factors for disease-specific survival. Versions 6 and 7 criteria are tacit regarding anatomic site and histology for tumors with identical FNCLCC grade.


Improved patient risk assessment may be achieved by staging using a larger number of size categories. Staging system refinements come at the cost of a larger number of staging categories. Histology or site-specific staging systems, nomograms or Bayesian belief networks may provide more accurate means to assess clinical outcomes.


Soft Tissue Sarcoma Soft Tissue Sarcoma Tumor Depth Primary Tumor Size Bayesian Belief Network 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The Research was support by NCI grants CA47179, CA140146, and CA142860.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Robert G. Maki
    • 1
    Email author
  • Nicole Moraco
    • 2
  • Cristina R. Antonescu
    • 3
  • Meera Hameed
    • 3
  • Alisa Pinkhasik
    • 2
  • Samuel Singer
    • 2
  • Murray F. Brennan
    • 2
  1. 1.Tisch Cancer Institute, Departments of Medicine, Pediatrics and OrthopaedicsMount Sinai School of MedicineNew YorkUSA
  2. 2.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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