Originally published as JCO Early Release 10.1200/JCO.2007.15.4542 on December 8 2008

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Soft Tissue Sarcomas of Childhood and Adolescence: The Prognostic Role of Tumor Size in Relation to Patient Body Size

Andrea Ferrari, Rosalba Miceli, Cristina Meazza, Elena Zaffignani, Alessandro Gronchi, Luigi Piva, Paola Collini, Marta Podda, Maura Massimino, Roberto Luksch, Graziella Cefalo, Monica Terenziani, Filippo Spreafico, Daniela Polastri, Franca Fossati-Bellani, Michela Casanova, Luigi Mariani

From the Pediatric Oncology, Melanoma Sarcoma Surgery, and Pediatric Surgery Units, Pathology Department, and Division of Medical Statistics and Biometry, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milano, Italy

Corresponding author: Andrea Ferrari, MD, Pediatric Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milano, Italy; e-mail: andrea.ferrari{at}istitutotumori.mi.it

Purpose Tumor size is a key prognostic variable for soft tissue sarcomas (STS), and a tumor diameter of 5 cm is generally used as a cutoff for risk grouping purposes. This study aimed to investigate the prognostic effect of tumor size on overall survival and whether such an effect was influenced by the patient's size, expressed as body-surface area (BSA), in a series of 553 pediatric patients with localized STS.

Patients and Methods Multivariable Cox models were used in which the effect of tumor size was adjusted for patients age, tumor site, histologic subtype, and Intergroup Rhabdomyosarcoma Study grouping, and the interaction between size and BSA was included.

Results Tumor size was confirmed as a significant prognostic factor. Interaction between size and BSA meant that, for a given tumor size, the mortality increased from the larger to the smaller BSA. Conversely, the mortality risk associated with a patient with a BSA of 1.75 m² and a 5-cm tumor was the same as for a 0.6 m² child with a 2.8-cm tumor.

Conclusion Tumor and body size are jointly informative on outcome. The risk associated with a given tumor size is not the same in patients of different body size, so it may be wrong to use the same 5-cm cutoff for tumor size in risk stratification.

published online ahead of print at www.jco.org on December 8, 2008.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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