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Tumours of Bone and Soft Tissues
Bone (ICD‐O‐3 C40, 41) Rules for Classification The classification applies to all primary malignant bone tumours except malignant lymphoma, multiple myeloma, surface/juxtacortical osteosarcoma, and juxtacortical chondrosarcoma. There should be histological confirmation of the disease and division of cases by histological type and grade. The following are the procedures for assessing T, N, and M categories: T categories Physical examination and imaging N categories Physical examination and imaging M categories Physical examination and imaging
Regional Lymph Nodes The regional lymph nodes are those appropriate to the site of the primary tumour. Regional node involvement is rare and cases in which nodal status is not assessed either clinically or pathologically could be considered N0 instead of NX or pNX.
TNM Clinical Classification T – Primary Tumour TX Primary tumour cannot be assessed T0 No evidence of primary tumour
Appendicular Skeleton, Trunk, Skull and Facial Bones T1 Tumour 8 cm or less in greatest dimension T2 Tumour more than 8 cm in greatest dimension T3 Discontinuous tumours in the primary bone site Spine T1 Tumour confined to a single vertebral segment or two adjacent vertebral segments T2 Tumour confined to three adjacent vertebral segments
T3 Tumour confined to four adjacent vertebral segments T4a Tumour invades into the spinal canal T4b Tumour invades the adjacent vessels or tumour thrombosis within the adjacent vessels Note
The five vertebral segments are the: Right pedicle Right body Left body Left pedicle Posterior element Pelvis T1a A tumour 8 cm or less in size and confined to a single pelvic segment with no extraosseous extension T1b A tumour greater than 8 cm in size and confined to a single pelvic segment with no extraosseous extension T2a A tumour 8 cm or less in size and confined to a single pelvic segment with extraosseous extension or confined to two adjacent pelvic segments without extraosseous extension T2b A tumour greater than 8 cm in size and confined to a single pelvic segment with extraosseous extension or confined to two adjacent pelvic segments without extraosseous extension T3a A tumour 8 cm or less in size and confined to two pelvic segments with extraosseous extension T3b A tumour greater than 8 cm in size and confined to two pelvic segment with extraosseous extension T4a Tumour involving three adjacent pelvic segments or crossing the sacroiliac joint to the sacral neuroforamen T4b Tumour encasing the external iliac vessels or gross tumour thrombus in major pelvic vessels Note
The four pelvic segments are the: Sacrum lateral to the sacral foramen, Iliac wing, Acetabulum/periacetabulum and Pelvic rami, symphysis and ischium
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Bone & Soft Tissues
Bone
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Tumours of Bone and Soft Tissues
N – Regional Lymph Nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis
M – Distant Metastasis M0 No distant metastasis M1 Distant metastasis M1a Lung M1b Other distant sites
pTNM Pathological Classification The pT and pN categories correspond to the T and N categories. For pM see page 8.
Stage – Appendicular Skeleton, Trunk, Skull and Facial Bones Stage IA Stage IB Stage IIA Stage IIB Stage III Stage IVA Stage IVB Stage IVB
T1 T2, T3 T1 T2 T3 Any T Any T Any T
N0 N0 N0 N0 N0 N0 N1 N0
M0 M0 M0 M0 M0 M1a Any M M1b
G1, GX Low Grade G1, GX Low Grade G2, G3 High Grade G2, G3 High Grade G2, G3 High Grade Any G Any G Any G
Stage – Spine and Pelvis There is no stage for bone sarcomas of the spine or pelvis.
Bone
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Prognostic factors for osteosarcoma Prognostic factors
Tumour related
Host related
Environment related
Essential
Location, size, extent of disease Tumour response to neoadjuvant chemotherapy
Age
Residual disease after resection
Additional
LDH Alkaline phosphatase
Gender Performance status
Management by a multidisciplinary sarcoma team Local recurrence
New and promising
Biomarkers
Source: UICC Manual of Clinical Oncology, Ninth Edition. Edited by Brian O’Sullivan, James D. Brierley, Anil K. D’Cruz, Martin F. Fey, Raphael Pollock, Jan B. Vermorken and Shao Hui Huang. © 2015 UICC. Published 2015 by John Wiley & Sons, Ltd.
Bone & Soft Tissues
Prognostic Factors Grid – Bone