Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma

Christopher W Ryan, MD
Janelle Meyer, MD
Section Editors
Robert Maki, MD, PhD
Raphael E Pollock, MD
Deputy Editor
Diane MF Savarese, MD


Sarcomas are a rare and heterogeneous group of malignant tumors of mesenchymal origin that comprise less than 1 percent of all adult malignancies and 12 percent of pediatric cancers [1-3]. Approximately 80 percent of sarcomas originate from soft tissue, and the rest originate from bone. There are approximately 12,390 new cases of soft tissue sarcoma diagnosed each year in the United States, with 4990 deaths [3].

The histopathologic spectrum of sarcomas is broad, presumably because the embryonic mesenchymal cells from which they arise have the capacity to mature into striated skeletal and smooth muscle, adipose and fibrous tissue, bone, and cartilage. Although ectodermal in origin, malignant tumors affecting peripheral nerves are included because of similarities in their clinical behavior, management, and outcome.

This topic review will cover the clinical presentation, diagnostic evaluation, and staging of soft tissue sarcoma other than gastrointestinal stromal tumor (GIST), the most common sarcoma, which is discussed in detail elsewhere. Issues specific to soft tissue sarcomas arising in the head and neck, retroperitoneum, and breast are discussed elsewhere, as are bone sarcomas, Kaposi sarcoma, and dermatofibrosarcoma protuberans (DFSP). (See "Head and neck sarcomas" and "Clinical features, evaluation, and treatment of retroperitoneal soft tissue sarcoma" and "Breast sarcoma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging" and "Osteosarcoma: Epidemiology, pathogenesis, clinical presentation, diagnosis, and histology" and "AIDS-related Kaposi sarcoma: Staging and treatment" and "Classic Kaposi sarcoma: Clinical features, staging, diagnosis, and treatment" and "Dermatofibrosarcoma protuberans: Epidemiology, pathogenesis, clinical presentation, diagnosis, and staging".)


As classified by the World Health Organization (WHO), the group of soft tissue sarcomas includes more than 100 different histologic subtypes [2]. The most common subtypes that arise in adults are outlined in the table (table 1).

WHO classifies most soft tissue sarcomas according to the presumptive tissue of origin (ie, the normal tissues the tumor most closely resembles) [2]. Examples include liposarcoma, synovial sarcoma, leiomyosarcoma, rhabdomyosarcoma (RMS), fibrosarcoma, and angiosarcoma. In some cases, histogenesis is uncertain, and the designation reflects the morphologic appearance of the cells or the architectural pattern (eg, alveolar sarcoma of soft parts, epithelioid sarcoma, clear cell sarcoma, Ewing sarcoma).


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jan 2017. | This topic last updated: Thu Jan 19 00:00:00 GMT+00:00 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Miller RW, Young JL Jr, Novakovic B. Childhood cancer. Cancer 1995; 75:395.
  2. Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F. World Health Organization Classification of tumours of soft tissue and bone, 4th, IARC Press, Lyon 2013.
  3. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
  4. Italiano A, Di Mauro I, Rapp J, et al. Clinical effect of molecular methods in sarcoma diagnosis (GENSARC): a prospective, multicentre, observational study. Lancet Oncol 2016; 17:532.
  5. Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer 2003; 97:2530.
  6. Coindre JM, Terrier P, Guillou L, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer 2001; 91:1914.
  7. Fletcher CD, Gustafson P, Rydholm A, et al. Clinicopathologic re-evaluation of 100 malignant fibrous histiocytomas: prognostic relevance of subclassification. J Clin Oncol 2001; 19:3045.
  8. Sanfilippo R, Miceli R, Grosso F, et al. Myxofibrosarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol 2011; 18:720.
  9. Gronchi A, Lo Vullo S, Colombo C, et al. Extremity soft tissue sarcoma in a series of patients treated at a single institution: local control directly impacts survival. Ann Surg 2010; 251:506.
  10. Look Hong NJ, Hornicek FJ, Raskin KA, et al. Prognostic factors and outcomes of patients with myxofibrosarcoma. Ann Surg Oncol 2013; 20:80.
  11. Conyers R, Young S, Thomas DM. Liposarcoma: molecular genetics and therapeutics. Sarcoma 2011; 2011:483154.
  12. Ghadimi MP, Liu P, Peng T, et al. Pleomorphic liposarcoma: clinical observations and molecular variables. Cancer 2011; 117:5359.
  13. Dei Tos AP, Pedeutour F. Atypical lipomatous tumour. In: WHO Classification of tumours of soft tissue and bone, 4th, Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F. (Eds), IARC, Lyon 2013. p.33.
  14. Italiano A, Bianchini L, Gjernes E, et al. Clinical and biological significance of CDK4 amplification in well-differentiated and dedifferentiated liposarcomas. Clin Cancer Res 2009; 15:5696.
  15. Rao UN, Finkelstein SD, Jones MW. Comparative immunohistochemical and molecular analysis of uterine and extrauterine leiomyosarcomas. Mod Pathol 1999; 12:1001.
  16. Svarvar C, Böhling T, Berlin O, et al. Clinical course of nonvisceral soft tissue leiomyosarcoma in 225 patients from the Scandinavian Sarcoma Group. Cancer 2007; 109:282.
  17. Arora VC, Price AP, Fleming S, et al. Characteristic imaging features of desmoplastic small round cell tumour. Pediatr Radiol 2013; 43:93.
  18. Fletcher CDM, Bridge JA, Lee J-C. Extrapleural solitary fibrous tumour. In: World health organization classification of tumours of soft tissue and bone, 4th, Fletcher CDM,Bridge JA, Hogendoorn PCW, Mertens F (Eds), IARC, Lyon 2013. p.80.
  19. Deyrup AT, Weiss SW. Grading of soft tissue sarcomas: the challenge of providing precise information in an imprecise world. Histopathology 2006; 48:42.
  20. Rubin BP, Fletcher CD, Inwards C, et al. Protocol for the examination of specimens from patients with soft tissue tumors of intermediate malignant potential, malignant soft tissue tumors, and benign/locally aggressive and malignant bone tumors. Arch Pathol Lab Med 2006; 130:1616.
  21. Guillou L, Coindre JM, Bonichon F, et al. Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol 1997; 15:350.
  22. Woodruff JM, Kourea HP, Louis DN, Schiethauer BW. Malignant peripheral nerve sheath tumour (MPNST). In: World Health Organization Classification of Tumours: Pathology and genetics of Tumours of the nervous system, Kleihues P, Cavenee WK (Eds), IARC Press, Lyon 2000. p.172.
  23. Stucky CC, Johnson KN, Gray RJ, et al. Malignant peripheral nerve sheath tumors (MPNST): the Mayo Clinic experience. Ann Surg Oncol 2012; 19:878.
  24. Lawrence W Jr, Donegan WL, Natarajan N, et al. Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg 1987; 205:349.
  25. Baratti D, Pennacchioli E, Casali PG, et al. Epithelioid sarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol 2007; 14:3542.
  26. Sakharpe A, Lahat G, Gulamhusein T, et al. Epithelioid sarcoma and unclassified sarcoma with epithelioid features: clinicopathological variables, molecular markers, and a new experimental model. Oncologist 2011; 16:512.
  27. Levy A, Le Péchoux C, Terrier P, et al. Epithelioid sarcoma: need for a multimodal approach to maximize the chances of curative conservative treatment. Ann Surg Oncol 2014; 21:269.
  28. Christie-Large M, James SL, Tiessen L, et al. Imaging strategy for detecting lung metastases at presentation in patients with soft tissue sarcomas. Eur J Cancer 2008; 44:1841.
  29. Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993; 217:72.
  30. Riad S, Griffin AM, Liberman B, et al. Lymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res 2004; :129.
  31. Mazeron JJ, Suit HD. Lymph nodes as sites of metastases from sarcomas of soft tissue. Cancer 1987; 60:1800.
  32. de Visscher SA, van Ginkel RJ, Wobbes T, et al. Epithelioid sarcoma: Still an only surgically curable disease. Cancer 2006; 107:606.
  33. Blazer DG 3rd, Lazar AJ, Xing Y, et al. Clinical outcomes of molecularly confirmed clear cell sarcoma from a single institution and in comparison with data from the Surveillance, Epidemiology, and End Results registry. Cancer 2009; 115:2971.
  34. Johannesmeyer D, Smith V, Cole DJ, et al. The impact of lymph node disease in extremity soft-tissue sarcomas: a population-based analysis. Am J Surg 2013; 206:289.
  35. AJCC (American Joint Committee on Cancer). Cancer Staging Manual, 7th edition, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York 2010. p.291.
  36. Pollock RE, Maki RG, Baldini EH, et al.. Soft Tissue Sarcoma of the Retroperitoneum. In: AJCC Cancer Staging Manual, 8th, Amin, MB. (Eds), AJCC, Chicago 2017. p.531.
  37. Yoon SS, Maki RG, Asare EA, et al.. Soft Tissue Sarcoma of the Trunk and Extremities. In: AJCC Cancer Staging Manual, 8th, Amin. MB. (Ed), AJCC, Chicago 2017. p.507.
  38. Vezeridis MP, Moore R, Karakousis CP. Metastatic patterns in soft-tissue sarcomas. Arch Surg 1983; 118:915.
  39. Potter DA, Glenn J, Kinsella T, et al. Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol 1985; 3:353.
  40. Lindberg RD, Martin RG, Romsdahl MM, Barkley HT Jr. Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer 1981; 47:2391.
  41. Weitz J, Antonescu CR, Brennan MF. Localized extremity soft tissue sarcoma: improved knowledge with unchanged survival over time. J Clin Oncol 2003; 21:2719.
  42. Billingsley KG, Lewis JJ, Leung DH, et al. Multifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcoma. Cancer 1999; 85:389.
  43. Rydholm A, Berg NO, Gullberg B, et al. Prognosis for soft-tissue sarcoma in the locomotor system. A retrospective population-based follow-up study of 237 patients. Acta Pathol Microbiol Immunol Scand A 1984; 92:375.
  44. Ryzewicz M, McLoughlin HA, Freudenberger C, et al. Unusual metastases from extremity soft tissue sarcomas. Orthopedics 2008; 31:439.
  45. Wang WL, Bones-Valentin RA, Prieto VG, et al. Sarcoma metastases to the skin: a clinicopathologic study of 65 patients. Cancer 2012; 118:2900.
  46. Schwab JH, Boland P, Guo T, et al. Skeletal metastases in myxoid liposarcoma: an unusual pattern of distant spread. Ann Surg Oncol 2007; 14:1507.
  47. Moreau LC, Turcotte R, Ferguson P, et al. Myxoid\round cell liposarcoma (MRCLS) revisited: an analysis of 418 primarily managed cases. Ann Surg Oncol 2012; 19:1081.
  48. Chotel F, Unnithan A, Chandrasekar CR, et al. Variability in the presentation of synovial sarcoma in children: a plea for greater awareness. J Bone Joint Surg Br 2008; 90:1090.
  49. Sinha S, Peach AH. Diagnosis and management of soft tissue sarcoma. BMJ 2010; 341:c7170.
  50. Hussein R, Smith MA. Soft tissue sarcomas: are current referral guidelines sufficient? Ann R Coll Surg Engl 2005; 87:171.
  51. Noria S, Davis A, Kandel R, et al. Residual disease following unplanned excision of soft-tissue sarcoma of an extremity. J Bone Joint Surg Am 1996; 78:650.
  52. Rehders A, Stoecklein NH, Poremba C, et al. Reexcision of soft tissue sarcoma: sufficient local control but increased rate of metastasis. World J Surg 2009; 33:2599.
  53. Bhangu AA, Beard JA, Grimer RJ. Should Soft Tissue Sarcomas be Treated at a Specialist Centre? Sarcoma 2004; 8:1.
  54. Gustafson P, Dreinhöfer KE, Rydholm A. Soft tissue sarcoma should be treated at a tumor center. A comparison of quality of surgery in 375 patients. Acta Orthop Scand 1994; 65:47.
  55. Sundaram M, McGuire MH, Herbold DR. Magnetic resonance imaging of soft tissue masses: an evaluation of fifty-three histologically proven tumors. Magn Reson Imaging 1988; 6:237.
  56. Demas BE, Heelan RT, Lane J, et al. Soft-tissue sarcomas of the extremities: comparison of MR and CT in determining the extent of disease. AJR Am J Roentgenol 1988; 150:615.
  57. Aisen AM, Martel W, Braunstein EM, et al. MRI and CT evaluation of primary bone and soft-tissue tumors. AJR Am J Roentgenol 1986; 146:749.
  58. Panicek DM, Gatsonis C, Rosenthal DI, et al. CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: Report of the Radiology Diagnostic Oncology Group. Radiology 1997; 202:237.
  59. Nieweg OE, Pruim J, van Ginkel RJ, et al. Fluorine-18-fluorodeoxyglucose PET imaging of soft-tissue sarcoma. J Nucl Med 1996; 37:257.
  60. Schwarzbach MH, Dimitrakopoulou-Strauss A, Willeke F, et al. Clinical value of [18-F]] fluorodeoxyglucose positron emission tomography imaging in soft tissue sarcomas. Ann Surg 2000; 231:380.
  61. Bastiaannet E, Groen H, Jager PL, et al. The value of FDG-PET in the detection, grading and response to therapy of soft tissue and bone sarcomas; a systematic review and meta-analysis. Cancer Treat Rev 2004; 30:83.
  62. Dimitrakopoulou-Strauss A, Strauss LG, Schwarzbach M, et al. Dynamic PET 18F-FDG studies in patients with primary and recurrent soft-tissue sarcomas: impact on diagnosis and correlation with grading. J Nucl Med 2001; 42:713.
  63. Folpe AL, Lyles RH, Sprouse JT, et al. (F-18) fluorodeoxyglucose positron emission tomography as a predictor of pathologic grade and other prognostic variables in bone and soft tissue sarcoma. Clin Cancer Res 2000; 6:1279.
  64. Lucas JD, O'Doherty MJ, Cronin BF, et al. Prospective evaluation of soft tissue masses and sarcomas using fluorodeoxyglucose positron emission tomography. Br J Surg 1999; 86:550.
  65. Benz MR, Czernin J, Dry SM, et al. Quantitative F18-fluorodeoxyglucose positron emission tomography accurately characterizes peripheral nerve sheath tumors as malignant or benign. Cancer 2010; 116:451.
  66. Ferner RE, Golding JF, Smith M, et al. [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a diagnostic tool for neurofibromatosis 1 (NF1) associated malignant peripheral nerve sheath tumours (MPNSTs): a long-term clinical study. Ann Oncol 2008; 19:390.
  67. Warbey VS, Ferner RE, Dunn JT, et al. [18F]FDG PET/CT in the diagnosis of malignant peripheral nerve sheath tumours in neurofibromatosis type-1. Eur J Nucl Med Mol Imaging 2009; 36:751.
  68. Levine E, Huntrakoon M, Wetzel LH. Malignant nerve-sheath neoplasms in neurofibromatosis: distinction from benign tumors by using imaging techniques. AJR Am J Roentgenol 1987; 149:1059.
  69. National Comprehensive Cancer Network (NCCN) guidelines www.nccn.org (Accessed on May 18, 2011).
  70. Schuetze SM, Rubin BP, Vernon C, et al. Use of positron emission tomography in localized extremity soft tissue sarcoma treated with neoadjuvant chemotherapy. Cancer 2005; 103:339.
  71. Al-Ibraheem A, Buck AK, Benz MR, et al. (18) F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of recurrent bone and soft tissue sarcoma. Cancer 2013; 119:1227.
  72. American College of Radiology (ACR) appropriateness criteria for follow-up of malignant or aggressive musculoskeletal tumors available online at http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/FollowupMalignantOrAggressiveMusculoskeletalTumors.pdf (Accessed on May 13, 2013).
  73. Mohammed TL, Chowdhry A, Reddy GP, et al. ACR Appropriateness Criteria® screening for pulmonary metastases. J Thorac Imaging 2011; 26:W1.
  74. ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii102.
  75. Pollock RE, Maki RG.. Introduction to Soft Tissue Sarcoma. In: AJCC Cancer Staging Manual, 8th, Amin, MB.. (Eds), AJCC, Chicago 2017. p.489.
  76. Noble JL, Moskovic E, Fisher C, Judson I. Imaging of skeletal metastases in myxoid liposarcoma. Sarcoma 2010; 2010:262361.
  77. Lucas JD, O'Doherty MJ, Wong JC, et al. Evaluation of fluorodeoxyglucose positron emission tomography in the management of soft-tissue sarcomas. J Bone Joint Surg Br 1998; 80:441.
  78. Johnson GR, Zhuang H, Khan J, et al. Roles of positron emission tomography with fluorine-18-deoxyglucose in the detection of local recurrent and distant metastatic sarcoma. Clin Nucl Med 2003; 28:815.
  79. Iagaru A, Chawla S, Menendez L, Conti PS. 18F-FDG PET and PET/CT for detection of pulmonary metastases from musculoskeletal sarcomas. Nucl Med Commun 2006; 27:795.
  80. Pastorino U, Veronesi G, Landoni C, et al. Fluorodeoxyglucose positron emission tomography improves preoperative staging of resectable lung metastasis. J Thorac Cardiovasc Surg 2003; 126:1906.
  81. Roberge D, Hickeson M, Charest M, Turcotte RE. Initial McGill experience with fluorodeoxyglucose pet/ct staging of soft-tissue sarcoma. Curr Oncol 2010; 17:18.
  82. Völker T, Denecke T, Steffen I, et al. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol 2007; 25:5435.
  83. National Comprehensive Cancer Network (NCCN) guidelines available online at www.nccn.org (Accessed on May 19, 2011).
  84. Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am 1982; 64:1121.
  85. Mankin HJ, Mankin CJ, Simon MA. The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am 1996; 78:656.
  86. Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF. Core needle biopsy for diagnosis of extremity soft tissue sarcoma. Ann Surg Oncol 1997; 4:425.
  87. Strauss DC, Qureshi YA, Hayes AJ, et al. The role of core needle biopsy in the diagnosis of suspected soft tissue tumours. J Surg Oncol 2010; 102:523.
  88. Woon DT, Serpell JW. Preoperative core biopsy of soft tissue tumours facilitates their surgical management: a 10-year update. ANZ J Surg 2008; 78:977.
  89. Serpell JW, Pitcher ME. Pre-operative core biopsy of soft-tissue tumours facilitates their surgical management. Aust N Z J Surg 1998; 68:345.
  90. Hau A, Kim I, Kattapuram S, et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002; 31:349.
  91. Dupuy DE, Rosenberg AE, Punyaratabandhu T, et al. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 1998; 171:759.
  92. Verheijen P, Witjes H, van Gorp J, et al. Current pathology work-up of extremity soft tissue sarcomas, evaluation of the validity of different techniques. Eur J Surg Oncol 2010; 36:95.
  93. Rougraff BT, Aboulafia A, Biermann JS, Healey J. Biopsy of soft tissue masses: evidence-based medicine for the musculoskeletal tumor society. Clin Orthop Relat Res 2009; 467:2783.
  94. Wakely PE Jr, Kneisl JS. Soft tissue aspiration cytopathology. Cancer 2000; 90:292.
  95. Trovik CS, Bauer HC, Brosjö O, et al. Fine needle aspiration (FNA) cytology in the diagnosis of recurrent soft tissue sarcoma. Cytopathology 1998; 9:320.
  96. American Joint Committee on Cancer Staging Manual, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York 2010. p.291.
  97. Salas S, Stoeckle E, Collin F, et al. Superficial soft tissue sarcomas (S-STS): a study of 367 patients from the French Sarcoma Group (FSG) database. Eur J Cancer 2009; 45:2091.
  98. Pisters PW, Leung DH, Woodruff J, et al. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996; 14:1679.
  99. Suit HD, Mankin HJ, Wood WC, et al. Treatment of the patient with stage M0 soft tissue sarcoma. J Clin Oncol 1988; 6:854.
  100. Ramanathan RC, A'Hern R, Fisher C, Thomas JM. Modified staging system for extremity soft tissue sarcomas. Ann Surg Oncol 1999; 6:57.
  101. Raut CP, Maki RG, Baldini EH, et al.. Soft Tissue Sarcoma of the Abdomen and Thoracic Visceral Organs. In: AJCC Cancer Staging Manual, 8th, Amin MB. (Ed), AJCC, Chicago 2017. p.517.
  102. Gronchi A, Miceli R, Shurell E, et al. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol 2013; 31:1649.
  103. Rööser B, Attewell R, Berg NO, Rydholm A. Prognostication in soft tissue sarcoma. A model with four risk factors. Cancer 1988; 61:817.
  104. Lahat G, Tuvin D, Wei C, et al. New perspectives for staging and prognosis in soft tissue sarcoma. Ann Surg Oncol 2008; 15:2739.
  105. Rubin BP, Cooper K, Fletcher CD, et al. Protocol for the examination of specimens from patients with tumors of soft tissue. Arch Pathol Lab Med 2010; 134:e31.
  106. Maki RG, Moraco N, Antonescu CR, et al. Toward better soft tissue sarcoma staging: building on american joint committee on cancer staging systems versions 6 and 7. Ann Surg Oncol 2013; 20:3377.
  107. Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol 2002; 20:791.
  108. http://www.mskcc.org/mskcc/html/6181.cfm (Accessed on May 18, 2011).
  109. Eilber FC, Brennan MF, Eilber FR, et al. Validation of the postoperative nomogram for 12-year sarcoma-specific mortality. Cancer 2004; 101:2270.
  110. Hajdu SI, Shiu MH, Brennan MF. The role of the pathologist in the management of soft tissue sarcomas. World J Surg 1988; 12:326.
  111. Mariani L, Miceli R, Kattan MW, et al. Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer 2005; 103:402.