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MRI features outperform histologic grade for outcome prediction in translocation-driven enriched soft-tissue sarcoma
Han-Ying Lin1,2, Ching-Lan Wu1,2, Chih-Hsueh Chen2,3
1Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.
Background:
Most MR-based prognostic series in soft-tissue sarcoma (STS) were derived in cohorts dominated by complex-karyotype histologies; whether conventional MR descriptors retain prognostic value in translocation-driven enriched populations is unclear. The purpose of our study is to identify preoperative MR features independently associated with overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) in a translocation-driven enriched soft-tissue sarcoma cohort.
Methods:
In this retrospective single-center study, consecutive adults with histologically confirmed STS who underwent contrast-enhanced MRI before treatment between January 2008 and December 2024 were evaluated. Two radiologists blinded to outcome independently scored 13 prespecified MR features. Cox regression adjusted for age, sex, maximum tumor diameter, and Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade was used to estimate hazard ratios (HRs); a sensitivity analysis added translocation-driven histology.
Results:
A total of 158 patients (mean age, 48 years ± 19 [SD]; 84 men) were evaluated; 61 of 152 classifiable patients (40%) had translocation-driven tumors. After adjustment for age, sex, and maximum tumor diameter, heterogeneous gadolinium enhancement was independently associated with shorter OS (HR, 3.9 [95% CI: 1.4, 10.7]; P = .008). Peritumoral edema was independently associated with shorter OS (HR, 2.0 [95% CI: 1.0, 3.7]; P = .04) and was the single independent MR predictor of LRFS (HR, 2.3 [95% CI: 1.2, 4.5]; P = .01). Both associations persisted after adjustment for translocation-driven histology. A 13-feature MR panel did not discriminate FNCLCC grade 3 (area under the curve [AUC], 0.59).
Conclusion:
Peritumoral edema and heterogeneous gadolinium enhancement were independent, complementary MR predictors of outcome in translocation-driven enriched soft-tissue sarcoma, outperforming FNCLCC grade and molecular histologic class. These findings require prospective multicenter validation before clinical application.
