AI Article Synopsis
- The study compares the prognostic accuracy of the 8th and 7th versions of the AJCC-staging system for soft tissue sarcomas (STS) in 1032 patients from European sarcoma centers.
- Both versions show similar accuracy for overall survival (C-indices: 0.620 for 8th vs. 0.614 for 7th) and can be improved with additional factors like age, gender, and histology.
- The 8th version's focus on tumor size, while neglecting tumor depth, delivers better discrimination among patients compared to the 7th version, suggesting the 8th version's simplification is beneficial.
Article Abstract
Background: The updated 8th version of the AJCC-staging system for soft tissue sarcomas (STS) has been criticised for omitting tumour depth as category-defining variable and eventually not improving prognostic accuracy in comparison to the 7th version. This study aimed at investigating the prognostic accuracy of both AJCC-versions in STS-patients treated at European tertiary sarcoma centres.
Methods: 1032 patients (mean age: 60.7 ± 16.3 years; 46.0% [n = 475] females; median follow-up: 38.6 months), treated at five tertiary sarcoma centres for localised, intermediate or high-grade STS of extremities and trunk were retrospectively included. Uni- and multivariate Cox-regression models and Harrell's C-indices were calculated to analyse prognostic factors for overall survival (OS) and assess prognostic accuracy.
Results: In univariate analysis, prognostic accuracy for OS was comparable for both AJCC-versions (C-index: 0.620 [8th] vs. 0.614 [7th]). By adding margins, age, gender, and histology to the multivariate models, prognostic accuracy of both versions could be likewise improved (C-index: 0.714 [8th] vs. 0.705 [7th]). Moreover, tumour depth did not significantly contribute to prognostic accuracy of the 8th version's multivariate model (C-index for both models: 0.714). Stratification into four main T-stages based on tumour size only, as implemented in the 8th version, significantly improved prognostic accuracy between each category. However, T-stages as defined in the 7th version had poorer discriminatory power (C-index: 0.625 [8th] vs. 0.582 [7th]).
Conclusion: Both AJCC-versions perform equally well regarding prognostic accuracy. Yet, simplification of the 8 version by omitting tumour depth as T-stage-defining parameter, whilst emphasizing the importance of tumour size, should be considered advantageous.
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| http://dx.doi.org/10.1016/j.ejso.2021.03.252 | DOI Listing |
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