TNM Classification for Osteogenic Sarcoma

The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification and staging system for osteogenic sarcoma are provided below.^[1]

Table. TNM Classification for Osteogenic Sarcoma (Open Table in a new window)

Primary Tumor (T)
Appendicular Skeleton, Trunk, Skull and Facial Bones
TX	Primary Tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor less than or equal to 8 cm
T2	Tumor more than 8 cm
T3	Discontinuous tumors in the primary bone site
Spine
TX	Primary Tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor confined to one vertebral segment or two adjacent vertebral segments
T2	Tumor confine to three vertebral segments
T3	Tumor confined to four or more adjacent vertebral segments or any nn adjacent segments
T4	Extension to the spinal canal or great vessels
T4a	Extension to the spinal canal
T4b	Evidence of gross vascular invasionor tumor thrombus in the great vessels
Pelvis
TX	Primary Tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor confine to one pelvic segment with no extraosseous extension
T1a	Tumor less than or equal to 8 cm in greatest dimension
T1b	Tumor more than 8 cm in greatest dimension
T2	Tumor confined to one pelvic segment with extraosseous extension or two segments without extraossous extension
T2a	Tumor less than or equal to 8 cm in greatest dimension
T2b	Tumor more than 8 cm in greatest dimension
T3	Tumor spanning two pelvic segments with extraosseous extension
T3a	Tumor less than or equal to 8 cm in greatest dimension
T3b	Tumor more than 8 cm in greatest dimension
T4	Tumor spanning three pelvic segments or crossing the sacroiliac joint
T4a	Tumor involves sacroiliac joint and extends medial to sacral neuroforamen
T4b	Tumor encasement of external iliac vessels or presence of gross tumor thrombus in major pelvic vessels
Regional lymph nodes (N)
NX	Regional lymph nodes cannot be assessed; because of rarity of lymph node involvement in bone sarcomas, the designation of NX may not be appropriate and cases should be considered N0 unless clinical node involvement is clearly evident
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis
Distant metastasis (M)
M0	No distant metastasis
M1	Distant metastasis
M1a	Lung
M1b	Bone and other distant sites
Histologic grade (G)
GX	Grade cannot be assessed
G1	Well differentiated, low grade
G2	Moderately differentiated, high grade
G3	Poorly differentiated, high grade

Table. Anatomic Stage/Prognostic Groups (Open Table in a new window)

Appendicular Skeleton, Trunk, Skull, and Facial Bones
When T is …	And N is …	And M is…	And the grade is …	Then stage group is …
T1	N0	M0	G1 or GX	IA
T2	N0	M0	G1 or GX	IB
T3	N0	M0	G1 or GX	IB
T1	N0	M0	G2 or G3	IIA
T2	N0	M0	G2 or G3	IIB
T3	N0	M0	G2 or G3	III
Any T	N0	M1a	Any G	IVA
Any T	N1	Any M	Any G	IVB
Any T	Any N	M1b	Any G	IVB

Media Gallery

of 0

Table. TNM Classification for Osteogenic Sarcoma

Primary Tumor (T)
Appendicular Skeleton, Trunk, Skull and Facial Bones
TX	Primary Tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor less than or equal to 8 cm
T2	Tumor more than 8 cm
T3	Discontinuous tumors in the primary bone site
Spine
TX	Primary Tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor confined to one vertebral segment or two adjacent vertebral segments
T2	Tumor confine to three vertebral segments
T3	Tumor confined to four or more adjacent vertebral segments or any nn adjacent segments
T4	Extension to the spinal canal or great vessels
T4a	Extension to the spinal canal
T4b	Evidence of gross vascular invasionor tumor thrombus in the great vessels
Pelvis
TX	Primary Tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor confine to one pelvic segment with no extraosseous extension
T1a	Tumor less than or equal to 8 cm in greatest dimension
T1b	Tumor more than 8 cm in greatest dimension
T2	Tumor confined to one pelvic segment with extraosseous extension or two segments without extraossous extension
T2a	Tumor less than or equal to 8 cm in greatest dimension
T2b	Tumor more than 8 cm in greatest dimension
T3	Tumor spanning two pelvic segments with extraosseous extension
T3a	Tumor less than or equal to 8 cm in greatest dimension
T3b	Tumor more than 8 cm in greatest dimension
T4	Tumor spanning three pelvic segments or crossing the sacroiliac joint
T4a	Tumor involves sacroiliac joint and extends medial to sacral neuroforamen
T4b	Tumor encasement of external iliac vessels or presence of gross tumor thrombus in major pelvic vessels
Regional lymph nodes (N)
NX	Regional lymph nodes cannot be assessed; because of rarity of lymph node involvement in bone sarcomas, the designation of NX may not be appropriate and cases should be considered N0 unless clinical node involvement is clearly evident
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis
Distant metastasis (M)
M0	No distant metastasis
M1	Distant metastasis
M1a	Lung
M1b	Bone and other distant sites
Histologic grade (G)
GX	Grade cannot be assessed
G1	Well differentiated, low grade
G2	Moderately differentiated, high grade
G3	Poorly differentiated, high grade

Table. Anatomic Stage/Prognostic Groups

Appendicular Skeleton, Trunk, Skull, and Facial Bones
When T is …	And N is …	And M is…	And the grade is …	Then stage group is …
T1	N0	M0	G1 or GX	IA
T2	N0	M0	G1 or GX	IB
T3	N0	M0	G1 or GX	IB
T1	N0	M0	G2 or G3	IIA
T2	N0	M0	G2 or G3	IIB
T3	N0	M0	G2 or G3	III
Any T	N0	M1a	Any G	IVA
Any T	N1	Any M	Any G	IVB
Any T	Any N	M1b	Any G	IVB