Grading of soft tissue sarcomas: necrosis as a determinant of survival.

: All cases of sarcomas of soft tissue occurring in males age 20-79 in Western Washington from 1981 to 1984 were studied with respect to the influence of multiple clinical, gross, and histologic parameters in predicting survival. Among histologic parameters studied, a strong and statistically significant association of necrosis of more than 15% of the tumor with death was observed. This effect was seen even when controlling for the influence of histology, site, stage of disease, and other factors. It is concluded that necrosis can serve as a prognostically relevant criterion for separating aggressive (nongrade 1) soft tissue sarcomas into intermediate grade (grade 2) and high grade (grade 3) tumors.