Review Question - QID 214525

A high-grade soft tissue sarcoma between 5-10 cm without lymph node involvement or metastatic disease would be considered a Stage IIIA tumor according to the eighth edition of the American Joint Commission on Cancer (AJCC).

The numerous subtypes of soft tissue sarcoma (STS) require a system based on multiple factors to better correlate with prognosis. The AJCC staging system is based on prognostic indicators - tumor size, lymph node involvement, metastatic disease, and tumor grade. This system allows interdisciplinary communication with non-orthopaedic specialties that routinely operate on soft tissue tumors (i.e., surgical oncologists and otolaryngologists). In addition, it serves as an adjunct to the National Comprehensive Cancer Network (NCCN) evidence-based treatment guidelines. The eighth edition, published in 2017, removed tumor depth, based on level II evidence that found it was not an independent risk factor.

Kotilingam et al. reviewed the staging of soft-tissue sarcomas and note they are a heterogeneous group of tumors that can occur in any soft tissue in the body. STS primarily disseminates hematogenously and typically metastasize to the lungs. Staging is useful in prognosis, design of effective multimodal treatment, and comparing treatment outcomes from different centers and eras. Prognostic factors not included in the AJCC STS staging system include the site of the primary tumor, margin status of resected tumor, molecular staging/prognostic markers, and whether the tumor is de novo or recurrent.

Illustration A is a table of the eighth edition AJCC

Incorrect Answers
Answer 1: Stage II are intermediate-grade tumors <5 cm without lymph node involvement or metastasis
Answer 3: Stage IIIB are intermediate or high-grade tumors >10 cm without lymph node involvement or metastasis
Answer 4: Stage IVA are any grade tumor of any size with lymph node involvement but no metastasis
Answer 5: Stage IVB are tumors of any grade tumor, size, and any lymph node involvement AND metastasis