5.2 Prognostic factors
The malignancy grade is the main prognostic factor in soft tissue sarcomas. The long term overall survival is expected to be >80-90in grade 1 sarcomas, as opposed to <40-50in grade 3 sarcomas. Grade 2 soft tissue sarcomas have an intermediate long term survival. In addition grade 3 sarcomas tend to recur earlier, i.e. in less than 2 years in most relapsing patients, than grade 2 sarcomas. Due to the coexistence of different malignancy grades within the same histotype, and the high number of different histotypes, histotype is less reliable as a prognostic factor than malignancy grade.
Tumor diameter is another important prognostic factor. As long as it increases, the prognosis gets worse. A conventional cuto-ff is generally set to 5-8 cm.
Deepness of the lesion may be a prognostic factor. In particular, it may divide grade 2 tumors into two groups: the superficial ones, with a long term survival close to grade 1 tumors, and the deep ones, with a long term survival close to grade 3 sarcomas.
Primary tumor site is a prognostic factor inasmuch as tumors arising in the trunk may easily reach great dimensions before giving rise to clinical symptoms. These tumors are more difficult to operate on, by comparison with limb sarcomas. In fact, they are generally not compartmental and surgical margins tend to be less adequate.
Other prognostic factors are currently being explored and some of them may turn out to be independent of grade, deepness and dimensions, such as, for example, tumor DNA content.
5.3 Predictive factors
From the surgical point of view, malignancy grade is a predictive factor for the presence of skip lesions outside the reactive zone and thereby for inadequacy of limited surgery. This prompts the surgeon to resort either to compartmental resections or to integrated radiosurgical approaches in high grade sarcomas.
From the medical point of view, malignancy grade may be a predictive factor of response to chemotherapy. High grade tumors would seem to respond better to chemotherapy than low grade ones. This may be less relevant in the metastatic disease, in which, by definition, malignancy grade cannot be considered truly low.
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