How are soft tissue sarcoma (STS) staged?

Updated: Sep 02, 2018
  • Author: Steven C Katz, MD, FACS; Chief Editor: Edwin Choy, MD, PhD  more...
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Answer

Answer

Both NCCN and ESMO follow the tumor-node-metastasis (TNM) classification of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) for staging of STS. Anatomic stage/prognostic groupings for STS are detailed in Tables 1 and 2, below. [5]

Table 1. Staging of Soft Tissue Sarcomas of the Trunk and Extremities (Open Table in a new window)

Stage

T

N

M

Histologic grade

Stage IA

T1

N0

M0

G1, GX

Stage IB

T2,T3, T4

N0

M0

G1, GX

Stage II

T1

N0

M0

G2, G3

Stage IIIA

T2

N0

M0

G2, G3

Stage IIIB

T3, T4

N0

M0

G2, G3

Stage IV

Any T

N1

M0

Any G

Any T

Any N

M1

Any G

For description of TNM designations, see Soft Tissue Sarcoma Staging.

Table 2. Staging of Retroperitoneal Sarcomas (Open Table in a new window)

Stage

T

N

M

Histologic grade

Stage IA

T1

N0

M0

G1, GX

Stage IB

T2-T4

N0

M0

G1, GX

Stage II

T1

N0

M0

G2, G3

Stage IIIA

T2

N0

M0

G2, G3

Stage IIIB

T3, T4

N0

M0

G2, G3

Any T

N1

M0

Any G

Stage IV

Any T

Any N

M1

Any G

GISTs are staged separately from other sarcomas. Histologic grade is replaced by mitotic activity and a cutoff of 5 mitoses per 5 mmstratifies low vs high mitotic rate (low mitotic rate: ≤5 mitoses per 5 mm2, high mitotic rate: > 5 mitoses per 5 mm2. GISTs arising primarily from the omentum should be staged according to the gastric GIST staging, while GISTs arising from all other sites should be staged according to the small intestinal group staging. Anatomic stage/prognostic groupings for GIST are detailed in Tables 3 and 4, below. [5]

Table 3. Staging of Gastric and Omental Gastrointestinal Stromal Tumors (Open Table in a new window)

Stage

T

N

M

Grade

IA

T1 or T2

N0

M0

Low

IB

T3

N0

M0

Low

II

T1

N0

M0

High

T2

N0

M0

High

T4

N0

M0

Low

IIIA

T3

N0

M0

High

IIIB

T4

N0

M0

High

IV

Any T

N1

M0

Any grade

Any T

Any N

M1

Any grade

Table 4. Staging of Small Intestine, Esophageal, Colorectal, Mesenteric, and Peritoneal Gastrointestinal Stromal Tumors (Open Table in a new window)

Stage

T

N

M

Mitotic Rate

I

T1 or T2

N0

M0

Low

II

T3

N0

M0

Low

IIIA

T1

N0

M0

High

T4

N0

M0

Low

IIIB

T2

N0

M0

High

T3

N0

M0

High

T4

N0

M0

High

IV

Any T

N1

M0

Any rate

Any T

Any N

M1

Any rate

For description of GIST TNM designations, see Gastrointestinal Stromal Tumors (GISTs) Staging.


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