COMPARATIVE-STUDY OF THE NATIONAL-CANCER-INSTITUTE AND FRENCH-FEDERATION-OF-CANCER-CENTERS SARCOMA GROUP GRADING SYSTEMS IN A POPULATION OF410 ADULT PATIENTS WITH SOFT-TISSUE SARCOMA

Purpose: Several histologic grading systems have been validated in sof t tissue sarcomas (STS), but no system is currently accepted worldwide . The National Cancer Institute (NCI) and French Federation of Cancer Centers Sarcoma Group (FNCLCC) systems were examined comparatively in the same population of patients with STS to determine which system is the best prognosticator with regard to metastasis development and tumo r mortality, Patients and Methods: Four hundred ten adult patients wit h nonmetastatic STS were examined. Histologic grade was established ac cording to the NCI and FNCLCC systems in each case. The prognostic val ue of both systems wan examined using univariate and multivariate (Cox 's model) analyses, and special attention was devoted to tumors with d iscordant grades. Results: In univariate analysis, bath the NCI and FN CLCC systems were of prognostic value to predict metastasis developmen t and tumor mortality. In multivariate analysis, high-grade tumors, ir respective of the system used, size greater than or equal to 10 cm, an d deep location were found to be independent prognostic factors for th e advent of metastases. Tumor grade had or higher predictive value tha n size or depth, and higher prognostic weight was assigned to the FNCL CC grading system in Cox models, Grade discrepancies were observed in 34.6% of the cases, An increased number of grade 3 STS, a reduced numb er of grade 2 STS, and a better correlation with overall and metastasi s-free survival within subpopulations with discordant grades were obse rved in favor of the FNCLCC system, Conclusion: The FNCLCC system show ed slightly increased ability to predict distant metastasis developmen t and tumor mortality. The use of this system to evaluate STS aggressi veness might be favored. (C) 1997 by American Society of Clinical Onco logy.