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1、认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目软组织肿瘤的分级与分期简介吴焕文认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目prognosisPrognosisofSTSisdominatedbylocalrecurrenceanddistantmetastasis.Overallsurvivalmainlydependsonmetastasis,butinsomelocalizations,suchasretroperitonealareas,ove
2、rallsurvivaldependsalsoonlocalrecurrence.Inmostreportedstudies,qualityofsurgicalmarginsisthemostimportantfactorforpredictinglocalrecurrence,whereasmetastasisandoverallsurvivalarerelatedmainlytohistologicgrade.Histopathologicalgradingfavourableprognosisorpoorprognosis;overallsurvival;appropriatetreat
3、mentregimenselection(Surgical,chemotherapeutic,andradiationtreatments)soft-tissuesarcomasprognosticfactors认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目Gradingofsofttissuesarcomaswasfirstproposedin1939byBroders,whousedacombinationofmitoticactivity,tumorgiantcells,andfibrousstromainassig
4、ningagradetofibrosarcomas.Brodersalsoacknowledgedtheimportanceofcellulardifferentiationingrading.ThefirstcoherentandeffectiveprognosticclassificationofSTSwasproposedbyRusselletal.in1977.ThissystemintroducedahistologicgradingapplicabletoalladultSTSs,whichwasthemostimportantfactor.Somehistologicaltype
5、ofTumorsaredefinitionallyhighgradeorlowgrade.Anumberofdifferentgradingsystemshavebeenproposedovertheyearsforsofttissuesarcomas,utilizing2tiered,3tiered,and4tieredstratificationschemes.lFrenchFederationofCancerCenters(FNCLCC)system(37.3%)lNationalCancerInstitute(NCI)(24%),lBroderscriteria(12%)lMarkhe
6、desystem(1.3%)lother(15.3%)认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目PARAMETERSUSEDINGRADING:lHistologicaltypelNecrosislMitoticactivitylTumourdifferentiationlCellularitylNuclearpleomorphismlVascularinvasion认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目Themostwidelyuseda
7、ndclinicallyvalidatedgradingsystemsare：NationalCancerInstitute(NCI)systemFrenchFederationofCancerCenters(FNCLCC)systemBothofwhichare3tieredsystems(Grade1,Grade2,Grade3).Atthepresenttime,theFNCLCCgradingsystemeaseofuseinterobserveragreementpredictivepower认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，
8、已经展开了“精准扶贫”项目NationalCancerInstitute(NCI)gradingsystemCriteriaforgradinghistologicdiagnosiscellularitycellularpleomorphismmitoticratenecrosis：necrosisemergedasamajordiscriminatingvariable.grade2and3tumorsexhibitingmoderateormarkednecrosis(15%)hadasignificantlypoorerprognosis.Three-gradesystemTheresp
9、ective5-yearsurvivalratesl100%(GradeI)l73%(GradeII)l46%(GradeIII)认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目NATIONALCANCERINSTITUTEGRADINGSYSTEM(NCI分级系统）分级系统）Gradinginthissystemisbasedonhistologicaltypeoftumourandtumournecrosiswherehistologicaltypedoesnotdefinegrade.HISTOLOGICALPARAM
10、ETERGRADEHISTOLOGICALTYPE/SUBTYPE1-Epithelioidhaemangioendothelioma-Welldifferentiatedliposarcoma-Myxoidliposarcoma-InfantilefibrosarcomaHISTOLOGICALTYPE,MITOSIS,DIFFERENTIATION1-Well-differentiatedleiomyosarcoma(6mitosis/10HPF)-Well-differentiatedfibrosarcoma(6mitosis/10HPF)-Malignantperipheralnerv
11、esheathtumour(5cminmaximumdiameter.N0Noclinicalregionallymphnodeinvolvement.N1Clinicalregionallymphnodeinvolvement.NXRegionallymphnodesnotexamined;noinformation.M0Nometastaticdisease.M1Metastaticdisease.认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目StageSitesofPrimaryTumorTStageTumorSiz
12、eRegionalLymphNodesDistantMetastasisIFavorablesites T1orT2AnysizeN0orN1orNX M0IIUnfavorablesitesT1orT2a,5cmN0orNXM0IIIUnfavorablesitesT1orT2a,5cmN1M0b,5cmN0orN1orNXIVAnysiteT1orT2AnysizeN0orN1orNX M1M0=absenceofmetastaticspread;M1=presenceofmetastaticspreadbeyondtheprimarysite;N0=absenceofnodalsprea
13、d;N1=presenceofnodalspreadbeyondtheprimarysite;X=unknownNstatus.Soft Tissue Sarcoma Committee of the Childrens Oncology Group Pretreatment Staging System 认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目GroupDefinitionI(Approximately13%ofallpatientsareinthisgroup.)Alocalizedtumorthatiscomp
14、letelyremovedwithpathologicallyclearmarginsandnoregionallymphnodeinvolvement.II(Approximately20%ofallpatientsareinthisgroup.)Alocalizedtumorthatisgrosslyremovedwith(a)microscopicdiseaseatthemargin,(b)involved,grosslyremovedregionallymphnodes,or(c)both(a)and(b).III(Approximately48%ofallpatientsareint
15、hisgroup.)Alocalizedtumorwithgrossresidualdiseaseafterincompleteremovalorbiopsyonly.IV(Approximately18%ofallpatientsareinthisgroup.)Distantmetastasesarepresentatdiagnosis.RiskGroupHistologyStageGroupLowriskEmbryonal1I,II,IIIEmbryonal2,3I,IIIntermediateriskEmbryonal2,3IIIAlveolar1,2,3I,II,IIIHighrisk
16、EmbryonalorAlveolar4IVSoft Tissue Sarcoma Committee of the Childrens Oncology Group Surgico-pathologic Group System SoftTissueSarcomaCommitteeoftheChildrensOncologyGroupRhabdomyosarcomaRiskGroupClassification认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目Prognosticparametersnotcurrentlyi
17、ncludedinthepresentAJCCSTSstagingsystemlAgeAgewasthemostconsistentadverseindependentprognosticfactorforsurvival.lNeurovascularandboneinvasionindependentpredictors:malignantfibroushistiocytomas;leiomyosarcomas;synovialsarcoma;认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目lHistologicsubty
18、pechildrenandadolescentsnon-rhabdomyosarcomasofttissuesarcoma(NRSTS):lessresponsivetoradiotherapyrhabdomyosarcoma:radiotherapycanbeusedinsteadofsurgeryembryonalsubtypesalveolarsubtypesretroperitonealsarcomas(RPSs)atypicallipomatoustumors(ALTs),non-ALTliposarcomas(LPSs)other认识到了贫困户贫困的根本原因，才能开始对症下药，然后
19、药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目lSiteofprimarydisease：认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目lSpecificmolecularprognosticmarkersllocalrecurrenceMostanalysesident
20、ifypreviouslocalrecurrenceasamajor(ifnotthemajor)riskfactorforsubsequentlocalrecurrence.认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目lMarginstatusPositivesurgicalmarginsarethemainpredictorsforlocalrelapse.Grade,size,andTNMstage(UICC/AJCC)havestrongerprognosticsignificanceforoverallsurv
21、ivalanddistantrecurrencethanforlocalrelapse.Itisbelievedgenerallythatsurgicalmarginsoflessthan1.5-2cminsofttissuesarcomapredisposetoanincreasedriskoflocalrecurrenceunlessfurthersurgeryorirradiationisundertaken.Howeverifasurgicalmarginisboundedbyanunbreachedlayeroffasciaorperiosteumthisriskprobablydo
22、esnotapply,butsuchmarginsshouldstillbemeasuredifclose.认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目EndpointAdversePrognosticFactorRelativeRiskLocalrecurrenceFibrosarcoma2.5Localrecurrenceatpresentation2.0Microscopicallypositivemargin1.8Malignantperipheralnervesheathtumor1.8Age50years1.
23、6DistantrecurrenceHighgrade4.3Deeplocation2.5Size5.09.9cm1.9Leiomyosarcoma1.7Nonliposarcomahistology1.6Localrecurrenceatpresentation1.5Size10.0cm1.5Disease-specificHighGrade4.0survivalDeeplocation2.8Size10.0cm2.1Malignantperipheralnervesheathtumor1.9Leiomyosarcoma1.9Microscopicallypositivemargin1.7L
24、owerextremitysite1.6Localrecurrenceatpresentation1.5MultivariateAnalysisofPrognosticFactorsinPatientswithExtremitySoft-TissueSarcoma认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目RECOMMENDATIONSFORTHEREPORTINGOFSOFTTISSUESARCOMAD
25、iagnosticInformation1.Siteanddepthoftumor(e.g.dermal,subcutaneous,fascial,subfascial,intramuscular,visceralormorethanoneofthese).2.Histologicaltype(useWHOsystemwhenpossible);iftumortypeisunknownthenthetermunclassifiedsarcomawithaqualifiersuchaspleomorphic,spindlecell,myxoidorroundcellisuseful.3.Maxi
26、maldimensionoftumor(incm);4.Histologicgrade;5.Minimumdistance(s)toresectionmargins-anymarginlessthan2cmfromthetumorshouldbespecifiedintermsoflocationanddistance;认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目6.Histologicevidenceofapre-existingbenignlesion(onlyapplicabletonervesheathneopl
27、asms);7.Lymphnodestatus(ifpresent);8.Resultsofanyspecialinvestigations(e.g.specialstains,immunohistochemistry,electronmicroscopy,DNAflowcytometry,karyotype).认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重视，已经展开了“精准扶贫”项目1.Mitoticrate,expressedasnumberofmitosesper10highpowerfields;2.Extentofnecrosis,asco
28、nfirmedhistologically;3.Presenceorabsenceofvascularinvasion,irrespectiveofvesseltype;4.Characteroflesionalmargin-e.g.circumscribed,focallyinfiltrative,diffuselyinfiltrative;5.Presence,extentandtypeofinflammatoryinfiltrate.OptionalFeaturesinDiagnosticReport认识到了贫困户贫困的根本原因，才能开始对症下药，然后药到病除。近年来国家对扶贫工作高度重
29、视，已经展开了“精准扶贫”项目参考文献1.TrojaniM,ContessoG,CoindreJM,RouesseJ,BuiNB,deMascarelA,GoussotJF,DavidM,BonichonF,LagardeC(1984).Soft-tissuesarcomasofadults;studyofpathologicalprognosticvariablesanddefinitionofahistopathologicalgradingsystem.IntJCancer33:37-42.2.HasegawaT.HistologicalgradingandMIB-1labelingin
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31、inicohistopathologiccorrelationinaseriesof163cases.Cancer53:530-541.5.RiadS,GriffinAM,LibermanB,etal.Lymphnodemetastasisinsofttissuesarcomainanextremity.ClinOrthopRelatRes2004;426:129346.HasegawaT,YokoyamaR,LeeYH,ShimodaT,BeppuY,HirohashiS.PrognosticrelevanceofahistologicalgradingsystemusingMIB-1for
32、adultsoft-tissuesarcoma.Oncology2000;58:6674.7.HasegawaT,YamamotoS,YokoyamaR,UmedaT,MatsunoY,HirohashiS.PrognosticsignificanceofgradingandstagingsystemsusingMIB-1scoreinadultpatientswithsofttissuesarcomaoftheextremitiesandtrunk.Cancer2002;95:8438.FletcherCD,BermanJJ,CorlessC,etal.Diagnosisofgastrointestinalstromaltumors:aconsensusapproach.Hum Pathol2002;33:45965.