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The American Joint Committee on Cancer (AJCC) 8th edition stage IV grouping for soft tissue sarcoma (STS) may obscure prognosis. Patients with nodal disease (N1M0) have a better overall survival than those with metastatic disease (N0-1M1).

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Area of Science:

  • Oncology
  • Cancer Staging
  • Sarcoma Research

Background:

  • The American Joint Committee on Cancer (AJCC) 8th edition now groups soft tissue sarcoma (STS) with nodal disease (N1M0) and metastatic disease (M1) into stage IV.
  • This new grouping may not accurately reflect the distinct prognoses of these patient subsets.

Purpose of the Study:

  • To evaluate if the AJCC 8th edition staging accurately represents the prognosis of STS patients with nodal disease (N1M0) versus metastatic disease (N0-1M1).
  • To determine if combining N1M0 and N0-1M1 into stage IV obscures prognostic differences.

Main Methods:

  • Analysis of adult STS patients from the National Cancer Database (2004-2014).
  • Patients were classified using the World Health Organization 2013 system and AJCC 8 staging.
  • Statistical analyses included chi-squared tests, Cox proportional hazard models, and propensity-score matched analyses.

Main Results:

  • Overall survival (OS) was significantly different between N1M0 and N0-1M1 STS patients at 5 and 10 years.
  • The N1M0 cohort demonstrated significantly greater OS compared to the N0-1M1 cohort in multivariate and propensity-matched analyses.
  • Hazard ratios indicated a more favorable prognosis for N1M0 STS.

Conclusions:

  • In adult STS, patients with N1M0 disease exhibit superior overall survival compared to those with N0-1M1 disease.
  • The AJCC 8th edition's grouping of N1M0 and N0-1M1 patients into stage IV may obscure the more favorable prognosis of N1M0 disease.
  • Re-evaluation of the AJCC 8th edition staging for STS may be warranted to better differentiate prognoses.