{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:52:07Z","timestamp":1777877527006,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82102776"],"award-info":[{"award-number":["82102776"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018904","name":"Beijing Xisike Clinical Oncology Research Foundation","doi-asserted-by":"publisher","award":["Y-Roche2019\/2-0049"],"award-info":[{"award-number":["Y-Roche2019\/2-0049"]}],"id":[{"id":"10.13039\/100018904","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective case series from 1990 to 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Participants<\/jats:title>\n                    <jats:p>This study included 471 patients diagnosed with HN-STS at Sun Yat-sen University Cancer Center between 1990 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>\n                      In the primary analysis, we obtained the overall survival (OS) rate. Secondary measures included area under the receiver operating characteristic curve, Harrell\u2019s\n                      <jats:italic toggle=\"yes\">C<\/jats:italic>\n                      , Somers\u2019\n                      <jats:italic toggle=\"yes\">D<\/jats:italic>\n                      , G\u00f6nen and Heller\u2019s\n                      <jats:italic toggle=\"yes\">K<\/jats:italic>\n                      , O\u2019Quigley\u2019s \u03c12\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      , Royston\u2019s\n                      <jats:italic toggle=\"yes\">R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      , the Bayesian information criterion for concordance, and variation in patient outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Additionally, the LGNM staging system demonstrated superior predictive ability and concordance compared with the seventh and eighth editions of AJCC staging systems.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/Relevance<\/jats:title>\n                    <jats:p>The LGNM staging system shows better homogeneity and discriminatory power than the AJCC system, improving risk stratification and prognosis prediction in HN-STS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19160216251333359","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T12:22:14Z","timestamp":1746102134000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Novel Location-Grading-Node-Metastasis Staging System in Patients With Head and Neck Soft Tissue Sarcoma"],"prefix":"10.1177","volume":"54","author":[{"given":"Dingfu","family":"Du","sequence":"first","affiliation":[{"name":"State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"},{"name":"Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaojun","family":"Wu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"},{"name":"Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zilu","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"},{"name":"Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanxiang","family":"Guan","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"},{"name":"Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Jiang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China"},{"name":"Department of Head and Neck Surgery, 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