Background:The prognostic value of treatment-induced necrosis in soft STS remains uncertain. This study evaluated whether MRI-based changes in necrosis (Δ necrosis) between pre- and post-neoadjuvant chemotherapy scans correlate with pathologic necrosis and clinical outcomes.Methods:In this retrospective cohort, 27 patients with STS who received neoadjuvant chemotherapy and underwent pre- and post-treatment MRI were analyzed. Necrosis was graded categorically (<5%, 5–25%, 25–50%, 50–75%, 75–95%, and >95%), and Δ necrosis was calculated as the change in estimated necrosis between scans. Correlations between MRI-derived and pathologic necrosis were assessed using Spearman’s rank coefficient. Survival analyses (progression-free, local recurrence-free, and disease-specific overall survival) were performed using Kaplan–Meier and log-rank tests.Results:Post-treatment MRI necrosis moderately correlated with pathologic necrosis (ρ = 0.44,p= 0.028), whereas Δ necrosis showed a weaker, nonsignificant correlation (ρ = 0.24,p= 0.24). Neither MRI-based nor pathologic necrosis thresholds were associated with survival outcomes.Conclusions:MRI-based Δ necrosis did not predict pathologic necrosis or oncologic outcomes in STS, suggesting that radiologic changes in necrosis may not serve as reliable markers of therapeutic response. Future studies integrating quantitative imaging and standardized pathology protocols together with future exploration of molecular tools such as ctDNA are needed to refine treatment assessment in STS.
背景：治疗诱导的软组织肉瘤坏死对预后的评估价值仍不明确。本研究旨在评估基于磁共振成像（MRI）测量的新辅助化疗前后坏死变化（Δ坏死）是否与病理坏死及临床结局相关。
方法：本回顾性队列纳入了27例接受新辅助化疗并在治疗前后进行MRI检查的软组织肉瘤患者。坏死按等级分类（＜5%、5–25%、25–50%、50–75%、75–95%及＞95%），Δ坏死定义为两次扫描间估计坏死程度的变化。采用斯皮尔曼等级相关系数评估MRI测量的坏死与病理坏死的相关性，并使用卡普兰-迈耶法及对数秩检验进行生存分析（无进展生存期、无局部复发生存期及疾病特异性总生存期）。
结果：治疗后MRI坏死与病理坏死呈中等程度相关（ρ = 0.44，p = 0.028），而Δ坏死则显示出较弱且无统计学意义的相关性（ρ = 0.24，p = 0.24）。基于MRI或病理坏死的阈值均未与生存结局显著相关。
结论：基于MRI的Δ坏死无法有效预测软组织肉瘤的病理坏死或肿瘤学结局，提示影像学上的坏死变化可能无法作为治疗反应的可靠标志物。未来需结合定量影像学与标准化病理学方案，并进一步探索如循环肿瘤DNA等分子工具，以优化软组织肉瘤的治疗评估。
肿瘤(癌症)患者之家