Huggett and Cates sought to compare the Vanderbilt stagingsystem for retroperitoneal sarcoma with both the seventh andeighth editions of the American Joint Committee on Cancer(AJCC) Cancer Staging Manual. In an independent cohort of 6857patients from the National Cancer Database, they assessed degreeof discrimination for stage groupings. Using several statisticalcriteria, they found that the eighth (current) edition of the manual,which recommends separating staging algorithms for soft-tissuesarcoma by anatomic site, was inferior to their proposed Vanderbiltsystem in categorizing risk of death. The latter system—whichincorporates measures of regional tumor extension or multifocalityin addition to information regarding histologic subtype—showedgreater discrimination between adjacent tumor stage groupings,higher predictive accuracy for 5-year survival, and more accurateprediction of clinical outcomes, resulting in a better-fittingregression model. Aspects of the Vanderbilt system seem worthyof further exploration in the quest for better staging systems in thisrare disease family.
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