What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer?

Insights into Imaging

Øyvind Salvesen¹  Mari K. Halle²  Jone Trovik²  David Forsse²  Camilla Krakstad²  Kathrine Woie²  Bjørn I. Bertelsen³  Kari S. Wagner-Larsen⁴  Ingfrid S. Haldorsen⁴  Njål Lura⁴ 

[1] Clinical Research Unit, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology;Department of Obstetrics and Gynecology, Haukeland University Hospital;Department of Pathology, Haukeland University Hospital;Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital;

关键词: MRI;    Cervical cancer;    Tumor size;    Disease-specific survival;   

DOI  :  10.1186/s13244-022-01239-y

来源: DOAJ

【 摘 要 】

Abstract Background Tumor size assessment by MRI is central for staging uterine cervical cancer. However, the optimal role of MRI-derived tumor measurements for prognostication is still unclear. Material and methods This retrospective cohort study included 416 women (median age: 43 years) diagnosed with cervical cancer during 2002–2017 who underwent pretreatment pelvic MRI. The MRIs were independently read by three radiologists, measuring maximum tumor diameters in three orthogonal planes and maximum diameter irrespective of plane (MAXimaging). Inter-reader agreement for tumor size measurements was assessed by intraclass correlation coefficients (ICCs). Size was analyzed in relation to age, International Federation of Gynecology and Obstetrics (FIGO) (2018) stage, histopathological markers, and disease-specific survival using Kaplan–Meier-, Cox regression-, and time-dependent receiver operating characteristics (tdROC) analyses. Results All MRI tumor size variables (cm) yielded high areas under the tdROC curves (AUCs) for predicting survival (AUC 0.81–0.84) at 5 years after diagnosis and predicted outcome (hazard ratios [HRs] of 1.42–1.76, p < 0.001 for all). Only MAXimaging independently predicted survival (HR = 1.51, p = 0.03) in the model including all size variables. The optimal cutoff for maximum tumor diameter (≥ 4.0 cm) yielded sensitivity (specificity) of 83% (73%) for predicting disease-specific death after 5 years. Inter-reader agreement for MRI-based primary tumor size measurements was excellent, with ICCs of 0.83–0.85. Conclusion Among all MRI-derived tumor size measurements, MAXimaging was the only independent predictor of survival. MAXimaging ≥ 4.0 cm represents the optimal cutoff for predicting long-term disease-specific survival in cervical cancer. Inter-reader agreement for MRI-based tumor size measurements was excellent.

【 授权许可】

Unknown