Early evaluation of liver metastasis using spectral CT to predict outcome in patients with colorectal cancer treated with FOLFOXIRI and bevacizumab

Abstract

Purpose Early evaluation of the efficacy of first-line chemotherapy combined with bevacizumab in patients with colorectal cancer liver metastasis (CRLM) remains challenging. This study used 2-month post-chemotherapy spectral computed tomography (CT) to predict the overall survival (OS) and response of CRLM patients with bevacizumab-containing therapy. Method This retrospective analysis was performed in 104 patients with pathologically confirmed CRLM between April 2017 and October 2021. Patients were treated with 5-fluorouracil, leucovorin, oxaliplatin or irinotecan with bevacizumab. Portal venous phase spectral CT was performed on the target liver lesion within 2 months of commencing chemotherapy to demonstrate the iodine concentration (IoD) of the target liver lesion. The patients were classified as responders (R +) or non-responders (R −) according to the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 at 6 months. Multivariate analysis was performed to determine the relationships of the spectral CT parameters, tumor markers, morphology of target lesions with OS and response. The differences in portal venous phase spectral CT parameters between the R + and R − groups were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the predictive power of spectral CT parameters. Results Of the 104 patients (mean age ± standard deviation: 57.73 years ± 12.56; 60 men) evaluated, 28 (26.9%) were classified as R + . Cox multivariate analysis identified the iodine concentration (hazard ratio [HR]: 1.238; 95% confidence interval [95% CI]: 1.089–1.408; P < 0.001), baseline tumor longest diameter (BLD) (HR: 1.022; 95% CI: 1.005–1.038, P = 0.010), higher baseline CEA (HR: 1.670; 95% CI: 1.016–2.745, P = 0.043), K-RAS mutation (HR: 2.027; 95% CI: 1.192–3.449; P = 0.009), and metachronous liver metastasis (HR: 1.877; 95% CI: 1.179–2.988; P = 0.008) as independent risk factors for patient OS. Logistic multivariate analysis identified the IoD (Odds Ratio [OR]: 2.243; 95% CI: 1.405–4.098; P = 0.002) and clinical N stage of the primary tumor (OR: 4.998; 95% CI: 1.210–25.345; P = 0.035) as independent predictor of R + . Using IoD cutoff values of 4.75 (100ug/cm3) the area under the ROC curve was 0.916, sensitivity and specificity were 80.3% and 96.4%, respectively. Conclusions Spectral CT IoD can predict the OS and response of patients with CRLM after 2 months of treatment with bevacizumab-containing therapy.

Viscoelastic properties of colorectal liver metastases reflect tumour cell viability

“…Li et al demonstrated that an early radiological evaluation of treatment response may also have a predictive value (33). Their group investigated the use of spectral computed tomography (CT) to evaluate the treatment response in patients suffering from CRLM and being treated with bevacizumab in combination with FOLFOX or FOLFIRI two months after the start of rst-line treatment.…”

Application of spectral CT in diagnosis, classification and prognostic monitoring of gastrointestinal cancers: progress, limitations and prospects

“…Although MRI and PET/CT have good performance in the early response evaluation of chemotherapy for CRLM, the high cost of them precludes their use in most patients with CRLM, because of multiple imaging examinations during chemotherapy. Li et al (2023) showed that IC of spectral CT, as independent risk factor for overall survival (OS) in CRLM patients (hazard ratio [HR]: 1.238), could well predict the early response of first-line chemotherapy combined to CRLM, using IC cutoff values of 4.75 (100ug/cm3) (AUC: 0.916), which meant that spectral CT could replace MRI and PET/CT to monitor the chemotherapy efficacy of CRLM in early stage.…”