Osteosarcoma staging: Difference between revisions

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__NOTOC__
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{{Osteosarcoma}}
{{Osteosarcoma}}
{{CMG}}; {{AE}}[[User:DrMars|Mohammadmain Rezazadehsaatlou[2]]].
{{CMG}}; {{AE}} [[User:DrMars|Mohammadmain Rezazadehsaatlou[2]]].
==Overview==
==Overview==
According to the American Joint Committee on Cancer (AJCC), there are four stages of osteosarcoma based on the size of [[primary tumor]], [[metastasis]], involvement of [[lymph nodes]], and grade of the tumor. For the purpose of treatment, there are only two stages of high-grade osteosarcoma: [[Localized disease|localized]] osteosarcoma and [[metastatic]] osteosarcoma.
According to the [[American Joint Committee on Cancer]] ([[American Joint Committee on Cancer|AJCC]]), there are four stages of [[osteosarcoma]] based on the size of [[primary tumor]], [[metastasis]], involvement of [[lymph nodes]], and grade of the tumor. For the purpose of treatment, there are only two stages of high-grade [[osteosarcoma]]: [[Localized disease|localized]] [[osteosarcoma]] and [[metastatic]] [[osteosarcoma]].


==Staging<ref name="pmid25070231">{{cite journal |vauthors=Moore DD, Luu HH |title=Osteosarcoma |journal=Cancer Treat. Res. |volume=162 |issue= |pages=65–92 |date=2014 |pmid=25070231 |doi=10.1007/978-3-319-07323-1_4 |url=}}</ref><ref name="pmid28195881">{{cite journal |vauthors=Cates JM |title=Comparison of the AJCC, MSTS, and Modified Spanier Systems for Clinical and Pathologic Staging of Osteosarcoma |journal=Am. J. Surg. Pathol. |volume=41 |issue=3 |pages=405–413 |date=March 2017 |pmid=28195881 |doi=10.1097/PAS.0000000000000774 |url=}}</ref><ref name="pmid29182106">{{cite journal |vauthors=Biazzo A, De Paolis M |title=Multidisciplinary approach to osteosarcoma |journal=Acta Orthop Belg |volume=82 |issue=4 |pages=690–698 |date=December 2016 |pmid=29182106 |doi= |url=}}</ref><ref name="pmid29200101">{{cite journal |vauthors=Cates JMM |title=Modeling Continuous Prognostic Factors in Survival Analysis: Implications for Tumor Staging and Assessing Chemotherapy Effect in Osteosarcoma |journal=Am. J. Surg. Pathol. |volume=42 |issue=4 |pages=485–491 |date=April 2018 |pmid=29200101 |doi=10.1097/PAS.0000000000000995 |url=}}</ref><ref name="pmid27138473">{{cite journal |vauthors=Jeys LM, Thorne CJ, Parry M, Gaston CL, Sumathi VP, Grimer JR |title=A Novel System for the Surgical Staging of Primary High-grade Osteosarcoma: The Birmingham Classification |journal=Clin. Orthop. Relat. Res. |volume=475 |issue=3 |pages=842–850 |date=March 2017 |pmid=27138473 |pmc=5289182 |doi=10.1007/s11999-016-4851-y |url=}}</ref>==
==Staging==
*Historically, the Enneking staging system for skeletal malignancies was widely used.
*Historically, the Enneking staging system for [[skeletal]] [[malignancies]] was widely used.<ref name="pmid25070231">{{cite journal |vauthors=Moore DD, Luu HH |title=Osteosarcoma |journal=Cancer Treat. Res. |volume=162 |issue= |pages=65–92 |date=2014 |pmid=25070231 |doi=10.1007/978-3-319-07323-1_4 |url=}}</ref><ref name="pmid28195881">{{cite journal |vauthors=Cates JM |title=Comparison of the AJCC, MSTS, and Modified Spanier Systems for Clinical and Pathologic Staging of Osteosarcoma |journal=Am. J. Surg. Pathol. |volume=41 |issue=3 |pages=405–413 |date=March 2017 |pmid=28195881 |doi=10.1097/PAS.0000000000000774 |url=}}</ref><ref name="pmid29182106">{{cite journal |vauthors=Biazzo A, De Paolis M |title=Multidisciplinary approach to osteosarcoma |journal=Acta Orthop Belg |volume=82 |issue=4 |pages=690–698 |date=December 2016 |pmid=29182106 |doi= |url=}}</ref><ref name="pmid29200101">{{cite journal |vauthors=Cates JMM |title=Modeling Continuous Prognostic Factors in Survival Analysis: Implications for Tumor Staging and Assessing Chemotherapy Effect in Osteosarcoma |journal=Am. J. Surg. Pathol. |volume=42 |issue=4 |pages=485–491 |date=April 2018 |pmid=29200101 |doi=10.1097/PAS.0000000000000995 |url=}}</ref><ref name="pmid27138473">{{cite journal |vauthors=Jeys LM, Thorne CJ, Parry M, Gaston CL, Sumathi VP, Grimer JR |title=A Novel System for the Surgical Staging of Primary High-grade Osteosarcoma: The Birmingham Classification |journal=Clin. Orthop. Relat. Res. |volume=475 |issue=3 |pages=842–850 |date=March 2017 |pmid=27138473 |pmc=5289182 |doi=10.1007/s11999-016-4851-y |url=}}</ref>
*This system inferred the aggressiveness of the primary tumor by the descriptors intracompartmental or extracompartmental.
*This system inferred the aggressiveness of the primary tumor by the descriptors intracompartmental or extracompartmental.
*The American Joint Committee on Cancer (AJCC) staging system for [[malignant]] bone tumors has updated this staging system, substituting compartmentalization with size.
*The [[American Joint Committee on Cancer]] ([[American Joint Committee on Cancer|AJCC]]) staging system for [[malignant]] bone tumors has updated this staging system, substituting compartmentalization with size.
*The International Union Against Cancer (UICC) uses the [[TNM system]] to describe the extent of many solid tumor [[cancers]].
*The [[International Union Against Cancer]] ([[International Union Against Cancer|UICC]]) uses the [[TNM system]] to describe the extent of many solid tumor [[cancers]].
*For the purpose of treatment, there are only two stages of high-grade osteosarcoma:
*For the purpose of treatment, there are only two stages of high-grade [[osteosarcoma]]:
'''Localized osteosarcoma:'''
'''Localized osteosarcoma:'''
*[[Localized mastocytosis|Localized]] tumors are limited to the bone of origin.
*[[Localized mastocytosis|Localized]] tumors are limited to the [[bone]] of origin.
*Patients with skip lesions confined to the bone that includes the primary tumor are considered to have localized disease if the skip lesions can be included in the planned [[surgical resection]].
*Patients with skip [[lesions]] confined to the bone that includes the primary tumor are considered to have localized disease if the skip lesions can be included in the planned [[surgical resection]].


'''Metastatic osteosarcoma:'''
'''Metastatic osteosarcoma:'''
*Patients in whom it is possible to detect any site of [[metastasis]] at the time of initial presentation by routine clinical studies are considered to have metastatic osteosarcoma.
*Patients in whom it is possible to detect any site of [[metastasis]] at the time of initial presentation by routine clinical studies are considered to have [[metastatic]] [[osteosarcoma]].
===TNM Staging system===
===TNM Staging system===
[[TNM]] stands for [[tumor]], [[Lymph nodes|nodes]], [[metastasis]]. TNM staging describes:
[[TNM]] stands for [[tumor]], [[Lymph nodes|nodes]], [[metastasis]]. [[TNM staging system|TNM]] staging describes:
*The size and extent of the primary tumor.
*The size and extent of the primary [[tumor]].
*The number and location of any regional lymph nodes that have cancer cells in them.
*The number and location of any regional [[Lymph node|lymph nodes]] that have cancer cells in them.
*Whether the cancer has spread or metastasized to another part of the body.
*Whether cancer has spread or [[metastasized]] to another part of the body.


{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
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| style="padding: 5px 5px; background: #e4e4e4;" | IA
| style="padding: 5px 5px; background: #e4e4e4;" | IA
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | Low
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | Low
| style="padding: 5px 5px; background: #e4e4e4;" | The tumor is 8 cm or less in size. It has not spread to lymph nodes or distant sites of the body.
| style="padding: 5px 5px; background: #e4e4e4;" | The [[tumor]] is 8 cm or less in size. It has not spread to lymph nodes or distant sites of the body.
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | IB
| style="padding: 5px 5px; background: #e4e4e4;" | IB
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | Low
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | Low
| style="padding: 5px 5px; background: #e4e4e4;" | The tumor is more than 8 cm in size. It has not spread to lymph nodes or distant sites of the body.
| style="padding: 5px 5px; background: #e4e4e4;" | The [[tumor]] is more than 8 cm in size. It has not spread to lymph nodes or distant sites of the body.
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | IIA
| style="padding: 5px 5px; background: #e4e4e4;" | IIA
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | High
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | High
| style="padding: 5px 5px; background: #e4e4e4;" | The tumor is 8 cm or less in size. It has not spread to lymph nodes or distant sites of the body.
| style="padding: 5px 5px; background: #e4e4e4;" | The [[tumor]] is 8 cm or less in size. It has not spread to lymph nodes or distant sites of the body.
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | IIB
| style="padding: 5px 5px; background: #e4e4e4;" | IIB
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | High
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | High
| style="padding: 5px 5px; background: #e4e4e4;" | The tumor is more than 8 cm in size. It has not spread to lymph nodes or distant sites of the body.
| style="padding: 5px 5px; background: #e4e4e4;" | The [[tumor]] is more than 8 cm in size. It has not spread to lymph nodes or distant sites of the body.
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | III
| style="padding: 5px 5px; background: #e4e4e4;" | III


| colspan="2" style="padding: 5px 5px; background: #e4e4e4;" | Any tumor grade, skip metastases.
| colspan="2" style="padding: 5px 5px; background: #e4e4e4;" | Any tumor grade, skip [[Metastasis|metastases]].
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | IV
| style="padding: 5px 5px; background: #e4e4e4;" | IV
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{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! colspan="4" |Enneking system for staging malignant musculoskeletal tumors
! colspan="5" |Enneking system for staging malignant musculoskeletal tumors
|-
|-
! style="background: #4682B4; color:#FFF;" | Stage
! style="background: #4682B4; color:#FFF;" | Stage
! style="background: #4682B4; color:#FFF;text-align: center;" | Tumor Grade
! style="background: #4682B4; color:#FFF;text-align: center;" | Tumor Grade
! style="background: #4682B4; color:#FFF;text-align: center;" | Tumor site
! style="background: #4682B4; color:#FFF;text-align: center;" | Tumor site
!
!Tumor Metastasis
!Tumor Metastasis
|-
|-
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| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | Low
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | Low
| style="padding: 5px 5px; background: #e4e4e4;" | Intracompartmental  
| style="padding: 5px 5px; background: #e4e4e4;" | Intracompartmental  
|
|No
|No
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | IB
| style="padding: 5px 5px; background: #e4e4e4;" | IB
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | Low
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | Low
| style="padding: 5px 5px; background: #e4e4e4;" | Extracompartimental
| style="padding: 5px 5px; background: #e4e4e4;" | Extra Compartimental
|
|No
|No
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | IIA
| style="padding: 5px 5px; background: #e4e4e4;" | IIA
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | High
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | High
| style="padding: 5px 5px; background: #e4e4e4;" | Intracompartimental
| style="padding: 5px 5px; background: #e4e4e4;" | Intracompartmental
|
|No
|No
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | IIB
| style="padding: 5px 5px; background: #e4e4e4;" | IIB
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | High
| style="padding: 5px 5px; background: #e4e4e4;text-align: center;" | High
| style="padding: 5px 5px; background: #e4e4e4;" | Extracompartimental
| style="padding: 5px 5px; background: #e4e4e4;" | Extra Compartimental
|
|No
|No
|-
|-
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| style="padding: 5px 5px; background: #e4e4e4;" | Any
| style="padding: 5px 5px; background: #e4e4e4;" | Any
|Any
|Any
|
|Any (Regional or distant)
|Any (Regional or distant)
|}
|}

Latest revision as of 18:38, 19 October 2019

Osteosarcoma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].

Overview

According to the American Joint Committee on Cancer (AJCC), there are four stages of osteosarcoma based on the size of primary tumor, metastasis, involvement of lymph nodes, and grade of the tumor. For the purpose of treatment, there are only two stages of high-grade osteosarcoma: localized osteosarcoma and metastatic osteosarcoma.

Staging

Localized osteosarcoma:

  • Localized tumors are limited to the bone of origin.
  • Patients with skip lesions confined to the bone that includes the primary tumor are considered to have localized disease if the skip lesions can be included in the planned surgical resection.

Metastatic osteosarcoma:

  • Patients in whom it is possible to detect any site of metastasis at the time of initial presentation by routine clinical studies are considered to have metastatic osteosarcoma.

TNM Staging system

TNM stands for tumor, nodes, metastasis. TNM staging describes:

  • The size and extent of the primary tumor.
  • The number and location of any regional lymph nodes that have cancer cells in them.
  • Whether cancer has spread or metastasized to another part of the body.
TNM staging of osteosarcoma
Stage Tumor Grade Tumor Size
IA Low The tumor is 8 cm or less in size. It has not spread to lymph nodes or distant sites of the body.
IB Low The tumor is more than 8 cm in size. It has not spread to lymph nodes or distant sites of the body.
IIA High The tumor is 8 cm or less in size. It has not spread to lymph nodes or distant sites of the body.
IIB High The tumor is more than 8 cm in size. It has not spread to lymph nodes or distant sites of the body.
III Any tumor grade, skip metastases.
IV Any tumor grade, any tumor size, distant metastases.
Enneking system for staging malignant musculoskeletal tumors
Stage Tumor Grade Tumor site Tumor Metastasis
IA Low Intracompartmental No
IB Low Extra Compartimental No
IIA High Intracompartmental No
IIB High Extra Compartimental No
III Any Any Any (Regional or distant)

References

  1. ↑ Moore DD, Luu HH (2014). "Osteosarcoma". Cancer Treat. Res. 162: 65–92. doi:10.1007/978-3-319-07323-1_4. PMID 25070231.
  2. ↑ Cates JM (March 2017). "Comparison of the AJCC, MSTS, and Modified Spanier Systems for Clinical and Pathologic Staging of Osteosarcoma". Am. J. Surg. Pathol. 41 (3): 405–413. doi:10.1097/PAS.0000000000000774. PMID 28195881.
  3. ↑ Biazzo A, De Paolis M (December 2016). "Multidisciplinary approach to osteosarcoma". Acta Orthop Belg. 82 (4): 690–698. PMID 29182106.
  4. ↑ Cates J (April 2018). "Modeling Continuous Prognostic Factors in Survival Analysis: Implications for Tumor Staging and Assessing Chemotherapy Effect in Osteosarcoma". Am. J. Surg. Pathol. 42 (4): 485–491. doi:10.1097/PAS.0000000000000995. PMID 29200101. Vancouver style error: initials (help)
  5. ↑ Jeys LM, Thorne CJ, Parry M, Gaston CL, Sumathi VP, Grimer JR (March 2017). "A Novel System for the Surgical Staging of Primary High-grade Osteosarcoma: The Birmingham Classification". Clin. Orthop. Relat. Res. 475 (3): 842–850. doi:10.1007/s11999-016-4851-y. PMC 5289182. PMID 27138473.
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