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1、软组织肿瘤的分级与分期简介吴焕文prognosisPrognosisofSTSisdominatedbylocalrecurrenceanddistantmetastasis.Overallsurvivalmainlydependsonmetastasis,butinsomelocalizations,suchasretroperitonealareas,overallsurvivaldependsalsoonlocalrecurrence.Inmostreportedstudies,qualityofsurgicalmarginsisthemostimpor
2、tantfactorforpredictinglocalrecurrence,whereasmetastasisandoverallsurvivalarerelatedmainlytohistologicgrade.Histopathologicalgradingfavourableprognosisorpoorprognosis;overallsurvival;appropriatetreatmentregimenselection(Surgical,chemotherapeutic,andradiationtreatments)soft-tissuesar
3、comasprognosticfactorsGradingofsofttissuesarcomaswasfirstproposedin1939byBroders,whousedacombinationofmitoticactivity,tumorgiantcells,andfibrousstromainassigningagradetofibrosarcomas.Brodersalsoacknowledgedtheimportanceofcellulardifferentiationingrading.Thefirstcoherentandeffectivepr
4、ognosticclassificationofSTSwasproposedbyRusselletal.in1977.ThissystemintroducedahistologicgradingapplicabletoalladultSTSs,whichwasthemostimportantfactor.SomehistologicaltypeofTumorsaredefinitionallyhighgradeorlowgrade.Anumberofdifferentgradingsystemshavebeenproposedovertheyearsforsof
5、ttissuesarcomas,utilizing2tiered,3tiered,and4tieredstratificationschemes.FrenchFederationofCancerCenters(FNCLCC)system(37.3%)NationalCancerInstitute(NCI)(24%),Broderscriteria(12%)Markhedesystem(1.3%)other(15.3%)PARAMETERSUSEDINGRADING:HistologicaltypeNecrosisMitoticactivityTumourdif
6、ferentiationCellularityNuclearpleomorphismVascularinvasionThemostwidelyusedandclinicallyvalidatedgradingsystemsare：NationalCancerInstitute(NCI)systemFrenchFederationofCancerCenters(FNCLCC)systemBothofwhichare3tieredsystems(Grade1,Grade2,Grade3).Atthepresenttime,theFNCLCCgradingsyste
7、measeofuseinterobserveragreementpredictivepowerNationalCancerInstitute(NCI)gradingsystemCriteriaforgradinghistologicdiagnosiscellularitycellularpleomorphismmitoticratenecrosis：necrosisemergedasamajordiscriminatingvariable.grade2and3tumorsexhibitingmoderateormarkednecrosis(>15%)hadas
8、ignificantlypoorerp
