Novel Location-Grading-Node-Metastasis Staging System in Patients With Head and Neck Soft Tissue Sarcoma

Q: What problem does the study address with the AJCC staging system for HN-STS?

The AJCC staging system has limitations that hinder accurate prognosis prediction for head and neck soft tissue sarcoma.

Q: How is the novel LGNM staging system constructed in this study?

It is based on primary tumor location and local invasion, categorized into four stages (L1–L4) with associated risk.

Q: What were the key survival findings of the LGNM staging system?

Five-year overall survival differed significantly across stages I to IV (96.9%, 78.4%, 37.1%, and 7.1%, respectively), and LGNM showed superior predictive ability compared with AJCC 7th and 8th editions.

Sep 23, 2026

Uploaded by Connor

Head and neck soft tissue sarcoma (HN-STS) is staged differently from many other head and neck cancers, but the current AJCC staging system limits accurate prognosis prediction. This retrospective study develops a novel LGNM (location-grading-node-metastasis) staging approach based on primary tumor location. In 471 patients treated at Sun Yat-sen University Cancer Center, LGNM stratified outcomes into stages I–IV with significant survival differences and improved predictive performance versus AJCC 7th and 8th editions. Overall survival estimates ranged from 96.9% to 7.1% across stages.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Importance and objective

Design, setting, and participants

Outcome measures

Results and conclusions

Keywords

Novel Location-Grading-Node-Metastasis Staging System in Patients With Head and Neck Soft Tissue Sarcoma Dingfu Du, MD, PhD 1 ,2*, Shaojun Wu, BSc 1 ,3*, Zilu Wang, BSc 1 ,3*, Yuanxiang Guan, BSc 1 ,3, Ke Jiang, MD, PhD 1 ,2, Bushu Xu, MD, PhD 1 ,4, and Yao Liang, MD, PhD 1 ,3 Abstract Journal of Otolaryngology-Head & Neck Surgery Volume 54: 1–11 © The Author(s) 2025 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/19160216251333359](DOI: 10.1177/19160216251333359)[ ](DOI: 10.1177/19160216251333359)[journals.sagepub.com/home/ohn](journals.sagepub.com/home/ohn) Importance. Unlike other head and neck cancers, head and neck soft tissue sarcoma (HN-STS) is staged similarly to sarcomas in the trunk and extremities. The current American Joint Committee on Cancer (AJCC) staging system has limitations that hinder accurate prognosis prediction for HN-STS. Objective. We aimed to develop a novel location-grading-node-metastasis (LGNM) staging system based on the primary tumor location to more accurately stratify prognosis for HN-STS. Design. A retrospective case series from 1990 to 2021. Setting/Participants. This study included 471 patients diagnosed with HN-STS at Sun Yat-sen University Cancer Center between 1990 and 2021. Main outcome measures. In the primary analysis, we obtained the overall survival (OS) rate. Secondary measures included area under the receiver operating characteristic curve, Harrell’s C, Somers’ D, Gönen and Heller’s K, O’Quigley’s ρ2k, Royston’s R2, the Bayesian information criterion for concordance, and variation in patient outcomes. Results. The eighth edition of AJCC T classification for tumor size inadequately conveys prognosis information. In contrast, the primary tumor location and local invasion are prognostic factors for HN-STS and categorized into 4 stages: L1 (low risk: scalp, face, supraclavicular, ear), L2 (intermediate risk: neck, paravertebral, pharynx, tonsil, eye, orbit), L3 (high risk: cavity, lip, palate, buccal mucosa, salivary gland, maxilla, mandible), and L4 (any location with local invasion). The new LGNM staging system effectively distributed patients into stages I to IV, with statistically-significant survival differences among these stages. Five-year OS rates were 96.9% for stage I, 78.4% for stage II, 37.1% for stage III, and 7.1% for stage IV (P < .001). Additionally, the LGNM staging system demonstrated superior predictive ability and concordance compared with the seventh and eighth editions of AJCC staging systems. Conclusions/Relevance. The LGNM staging system shows better homogeneity and discriminatory power than the AJCC system, improving risk stratification and prognosis prediction in HN-STS. Keywords head and neck, soft tissue sarcoma, LGNM staging system, AJCC staging system, prognosis Received February 6, 2024; accepted February 7, 2025. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ([https://us.sagepub.com/en-us/nam/open-access-at-sage](https://us.sagepub.com/en-us/nam/open-access-at-sage)). Graphical Abstract 1 State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China 2Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China 3Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China 4Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Cent

FAQs

What problem does the study address with the AJCC staging system for HN-STS?

The AJCC staging system has limitations that hinder accurate prognosis prediction for head and neck soft tissue sarcoma.

How is the novel LGNM staging system constructed in this study?

It is based on primary tumor location and local invasion, categorized into four stages (L1–L4) with associated risk.

What were the key survival findings of the LGNM staging system?

Five-year overall survival differed significantly across stages I to IV (96.9%, 78.4%, 37.1%, and 7.1%, respectively), and LGNM showed superior predictive ability compared with AJCC 7th and 8th editions.

Sep 23, 2026

Uploaded by Connor