Kattan et al developed a nomogram for predicting the probability of sarcoma-specific death (SSD) at 12 years after surgery in patients with sarcoma. This can help relate the chances for survival to the patient and family which can help in the making of informed decisions for management. The authors are from the Memorial Sloan-Kettering Cancer Center in New York and Singapore Management University in Singapore.
Exclusions:
(1) Patients presenting with a recurrence.
(2) Sarcomas of the skin.
Parameters:
(1) size in cm
(2) depth of tumor
(3) anatomic site
(4) histology
(5) age of the patient
(6) histologic grade
|
Parameter |
Finding |
Points |
|---|---|---|
|
size of the tumor |
<= 5 cm |
0 |
|
|
5.1 to 10 cm |
44 |
|
|
> 10 cm |
70 |
|
depth |
superficial |
0 |
|
|
deep |
29 |
|
site (anatomic location) |
upper extremity |
0 |
|
|
lower extremity |
6 |
|
|
visceral |
27 |
|
|
thoracic or trunk |
31 |
|
|
retroperitoneal or intra-abdominal |
39 |
|
|
head and neck |
61 |
|
histologic type |
fibrosarcoma |
0 |
|
|
liposarcoma |
39 |
|
|
malignant fibrous histiocytoma (MFH) |
50 |
|
|
leiomyosarcoma |
60 |
|
|
synovial sarcoma |
70 |
|
|
malignant peripheral nerve tumor (MPNT) |
100 |
|
|
other |
65 |
where:
• There may be some confusion in assigning a score for a sarcoma arising in an abdominal viscera, since visceral, trunk and intra-abdominal might all apply. It may not make difference on outcome since the points for all 3 are fairly close to each other.
|
Age |
Points |
|---|---|
|
< 16 |
0 |
|
16 - 90 |
(0.00208 * ((age in years)^2)) + (0.70703 * (age in years)) – 12.394 |
|
> 90 |
67 |
point score for the patient =
= SUM(points for the 5 graded parameters)
Interpretation:
• minimum score: 0
• maximum score: 327
• The higher the score, the lower the predicted survival (the higher the mortality rate).
Predicting 12 year sarcoma-specific death, based on tumor grade (low vs high)
|
Points |
Low Grade |
High Grade |
|---|---|---|
|
0 |
|
|
|
3 |
|
0.04 |
|
10 |
|
0.044 |
|
20 |
|
0.05 |
|
30 |
|
0.06 |
|
40 |
|
0.07 |
|
50 |
|
0.081 |
|
60 |
|
0.095 |
|
70 |
0.04 |
0.12 |
|
80 |
0.048 |
0.14 |
|
90 |
0.054 |
0.155 |
|
100 |
0.066 |
0.19 |
|
110 |
0.075 |
0.21 |
|
120 |
0.09 |
0.25 |
|
130 |
0.105 |
0.28 |
|
140 |
0.125 |
0.32 |
|
150 |
0.142 |
0.375 |
|
160 |
0.166 |
0.42 |
|
170 |
0.19 |
0.48 |
|
180 |
0.23 |
0.53 |
|
190 |
0.26 |
0.58 |
|
200 |
0.29 |
0.65 |
|
210 |
0.35 |
0.71 |
|
220 |
0.39 |
0.78 |
|
230 |
0.44 |
0.82 |
|
240 |
0.50 |
0.875 |
|
250 |
0.55 |
0.91 |
|
260 |
0.62 |
0.94 |
|
270 |
0.68 |
0.96 |
|
280 |
0.725 |
0.975 |
|
290 |
0.79 |
0.99 |
|
300 |
0.85 |
> 0.99 |
|
310 |
0.88 |
> 0.99 |
When the data is analyzed in JMP, a cumulative probability curve is generated. These can be broken up based on score ranges and the curves approximated.
|
Low Grade |
Equation |
|---|---|
|
70 – 190 |
(0.0000127 * ((points)^2) – (0.001531 * (points)) + 0.0882468 |
|
190 – 250 |
(0.0049286 * (points)) - 0.687143 |
|
250 - 310 |
(-0.000019 * ((points)^2) + (0.0162381 * (points)) – 2.317857 |
|
High Grade |
Equation |
|---|---|
|
0 - 140 |
(0.0000129 * ((points)^2) + (0.0001642 * (points)) + 0.0412305 |
|
140 – 190 |
(0.0052143 * (points)) - 0.409524 |
|
190 - 290 |
(-0.000035 * ((points)^2) + (0.020939 * (points)) – 2.134163 |
Limitations:
• A patient with metastatic disease at the time of surgery would be expected to have a worse prognosis. I need to read the paper more carefully to see how this was handled.
Specialty: Hematology Oncology, Surgery, general, Surgery, orthopedic
ICD-10: ,
