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

Insights into Imaging

Table 1 MRI-assessed maximum tumor diameter (MAX_imaging) and tumor volume (TVOL_imaging) in relation to clinical and histological characteristics in 416 patients with cervical cancer

Variable	N	MAX_imaging, cm median (IQR)	P	TVOL_imaging, cl median (IQR)	p
FIGO (2018) stage (n = 416)			< 0.001***		< 0.001***
I	260	0 (0–3.0)		0 (0–0.5)
II	50	4.7 (3.8–6.0)		2.4 (1.2–5.0)
III	81	5.4 (4.6–6.5)		4.0 (1.9–6.5)
IV	25	6.2 (4.6–7.6)		6.0 (2.4–9.6)
Clinical tumor size (cm) (n = 230)			< 0.001***		< 0.001***
< 2	46	1.4 (0–3.2)		0.1 (0–0.7)
2–4	109	3.8 (2.9–4.6)		1.0 (0.4–2.6)
> 4	75	5.6 (4.7–6.7)		4.4 (2.3–7.0)
Primary treatment (n = 416)			< 0.001**		< 0.001**
Surgery only^a	210	0 (0–2.1)		0 (0–0.2)
Surgery^a and adjuvant treatment	51	3.3 (1.5–4.5)		1.0 (0.1–2.2)
Primary radiotherapy with or without chemotherapy	147	5.1 (4.2–6.3)		3.3 (1.4–6.1)
Other^b	8	7.2 (6.0–8.6)		6.4 (5.1–15.9)
Histologic subtype (n = 416)			0.03**		0.03**
Adenocarcinoma	92	2.1 (0–4.0)		0.2 (0–1.2)
Squamous cell carcinoma	292	3.2 (0–4.9)		0.6 (0–3.1)
Other^c	32	3.8 (0–5.4)		1.1 (0–4.7)
Histologic grade (n = 343)			< 0.001*		< 0.001*
Low/medium	253	3.0 (0–4.7)		0.4 (0–2.5)
High	90	4.3 (1.8–5.6)		1.6 (0.1–4.5)
Parametrial infiltration (n = 205)			0.006*		0.006*
No	200	0 (0–2.7)		0 (0–0.4)
Yes	5	4.8 (3.0–6.9)		3.0 (0.5–6.4)
Lymph node metastasis (n = 200)			0.02*		0.02*
No	177	1.1 (0–3.0)		0.03 (0–0.5)
Yes	23	3.0 (0–4.6)		0.5 (0–2.1)

	MAX_imaging			TVOL_imaging^d
Dependent variables	R²	β	P	R²	Β	p
Linear regression for continuous variables^e
Age (decade) (n = 416)	0.10	0.62	< 0.001	0.11	0.17	< 0.001
Histopathological MAX_histology(cm) (n = 212)	0.73	0.82	< 0.001	0.69	0.20	< 0.001
Microscopic depth of invasion (cm) (n = 181)	0.41	2.75	< 0.001	0.43	0.79	< 0.001

FIGO, International Federation of Gynecology and Obstetrics; IQR, interquartile range; MAX_histology, maximum histological tumor diameter
P values corrected for multiple testing of each size variable by Holm–Bonferroni method. Significant p values are given in boldface
^*Mann–Whitney U test
^**Kruskal–Wallis H test
^***Jonckheere–Terpstra trend test
^aPrimary surgical treatment in 225 patients consisted of radical hysterectomy (n = 199), simple hysterectomy (n = 25), and cervical amputation (n = 1) (surgical procedure: laparotomy (n = 191), robot-assisted laparoscopy (n = 25), or conventional laparoscopy (n = 9)), whereas 36 patients were surgically treated with conization (n = 31) or fertility-sparing surgery (n = 5)
^bPalliation (n = 1) or only chemotherapy (n = 7)
^cAdenosquamous (n = 14), neuroendocrine (n = 9), or undifferentiated carcinoma (n = 9)
^dThe third root of the tumor volume
^eLinear models with MAX_imaging or TVOL_imaging as dependent variables