Dimensional assessment on baseline MRI of soft-tissue sarcomas: longest diameter, sum and product of diameters, and volume-which is the best measurement method to predict patients' outcomes?

Valerio D'Agostino ¹, Federico Ponti ¹, Claudia Martella ¹

⁰Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli 1, 40136, Bologna, Italy.

La Radiologia Medica +

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October 18, 2024

View abstract on PubMed

Summary

The longest diameter (LD) is the most effective metric for predicting metastasis-free survival in lower limb soft-tissue sarcoma (STS). Other dimensional measurements showed similar prognostic value but LD offers the best balance of simplicity and performance.

Area Of Science

Oncology
Radiology
Surgical Pathology

Background

The longest diameter (LD) is a recognized prognostic factor for soft-tissue sarcoma (STS).
Alternative dimensional assessments like sum of diameters (SoD), product of diameters (PoD), and 3D-COG volume exist but their comparative prognostic value against LD is unknown.
Accurate prognostication is crucial for tailoring treatment strategies in STS patients.

Purpose Of The Study

To compare the prognostic performance of LD, SoD, PoD, and 3D-COG in predicting metastasis-free survival (MFS) for lower limb STS.
To evaluate the utility of these dimensional assessments in improving patient prognostication.
To assess the reproducibility of these measurements.

Main Methods

Retrospective analysis of 382 adult patients with newly diagnosed lower limb STS treated with curative intent.
Multivariable Cox regression models were developed using LD, PoD, SoD, or 3D-COG, with adjustment for clinical covariates.
Model performance was compared using concordance indices (c-indices) in a validation cohort; measurement reproducibility was assessed using intraclass correlation coefficients (ICCs).

Main Results

All dimensional measurements were associated with lower metastasis-free survival (MFS).
The product of diameters (PoD) model showed the highest concordance index in both training and validation cohorts, though not significantly superior to the longest diameter (LD) model.
No dimensional measurement was significantly associated with overall survival (OS) or local relapse-free survival (LFS); all demonstrated excellent measurement reproducibility (ICC > 0.95).

Conclusions

The longest diameter (LD) is the most suitable metric for integration into prognostic models and nomograms for predicting metastasis-free survival in lower limb soft-tissue sarcoma.
While other dimensional measurements offer comparable prognostic information, LD provides the optimal balance of simplicity and predictive performance.
Further research may explore the combined utility of LD with other clinical factors for enhanced prognostication.

Keywords:

Diagnostic imaging Lower extremity Magnetic resonance imaging Measures Neoplasm staging Patient outcome assessment Soft-tissue sarcoma

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