Saji Francis, Ramakrishnan Jayalekshmi, Krishna Govindan Balachandran Nair, Jayaprakash Madhavan
BACKGROUND Soft tissue sarcomas (STS) account for less than 1% of all malignant tumours but present a significant diagnostic and therapeutic challenge since there are more than 50 histological subtypes.1 The clinical course of a sarcoma cannot be predicted by histologic typing alone but must be accompanied by grading and staging. Sarcomas with high metastatic potential can be picked out by histologic grading which is a cheap and simple method. One widely used and most reproducible grading system is French Federation Nationale des Centres de Lutte Contre le Cancer (FNCLCC) based on a score obtained by evaluating tumour differentiation, mitotic rate and amount of tumour necrosis.2 Histologic grading is the mainstay in predicting prognosis of STS especially in centres where facilities for more sophisticated methods are not available. Hence this study was undertaken to assess the effectiveness of the FNCLCC grading system in the prognostication of STS in our patient population. Aims and Objectives 1. To grade soft tissue sarcomas according to the FNCLCC system. 2. To study the association between grade and survival of soft tissue sarcomas in the patient population. MATERIALS AND METHODS The cases selected were adult patients with soft tissue sarcomas whose excision specimens were received in the Department of Pathology, Medical College, Thiruvananthapuram during a 3-year period for diagnosis. Histopathology slides of these tumours were retrieved and graded according to the FNCLCC system. The patients were followed up for 5 years. Overall and disease-free survival rates were estimated. The data was analysed with the help of computer software SPSS. RESULTS Of the 110 cases of soft tissue sarcoma reviewed, 27.3% were low grade, 49% intermediate grade and 23.7% high grade. Follow up was available only for 70 patients with STS. The prognostic factors found significant in univariate analysis were histologic grade, necrosis and mitosis. But by multivariate analysis only histologic grade and necrosis were found to be independent prognostic factors. CONCLUSION Histologic grading of soft tissue sarcomas definitely influences the survival of patients and it should be routinely mentioned while reporting soft tissue sarcomas. FNCLCC grading system may be modified giving more importance to necrosis.
