Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Abstract

Purposes: To date, most studies about the optimal number of target lesions for enhancement criteria for hepatocellular carcinoma (HCC) have focused on cross-sectional analyses of concordance. We investigated the optimal number of target lesions for European Association for the Study of the Liver (EASL) and modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines in predicting overall survival (OS).Experimental Design: We analyzed 254 consecutive treatment-na€ ve patients with HCC having at least 2 measurable target lesions undergoing transarterial chemoembolization. Kappa values for intermethod agreement of treatment responses were calculated for comparisons between use of maximum of 1, 2, 3, 4, or 5 targets versus use of all target lesions. Prognostic values of radiologic assessments according to number of target lesions for predicting OS were expressed as C-index.Results: By EASL and mRECIST guidelines, k values between responses assessing the longest 2, 3, 4, or 5 targets and assessing all targets were 0.924, 0.977, 1.000, or 1.000 and 0.907, 0.959, 1.000, or 1.000, respectively, whereas those between responses assessing only one target and assessing all target lesions were 0.723 and 0.666, respectively. C-index when measuring the longest 1, 2, 3, 4, 5, and all targets was similar, ranging from 0.739 to 0.749 for EASL criteria and from 0.750 to 0.759 for mRECIST. From Cox regression analyses, radiologic response from each calculation method showed independently significant effects on OS for both guidelines, regardless of number of target lesions.Conclusions: Prognostic values for predicting OS were similar regardless of number of target lesions. Assessing the 2 largest targets rather than only 1 index lesion could be recommended considering high concordances from cross-sectional analyses.

Transarterial chemoembolization in soft-tissue sarcoma metastases to the liver – The use of imaging biomarkers as predictors of patient survival

“…Second, our study protocol did not include the assessment of multiple target lesions. However, several recent reports did not confirm the benefits of a multi-lesion assessment in the setting of intraarterial therapies [15]. Specifically, semi-automated 3D analysis offers a higher diagnostic accuracy and improved reproducibility of measurements making it less susceptible to reader bias, thus making multiple lesion analysis unnecessary.…”

“…A single targeted lesion per patient was selected for analysis. The analysis of multiple target lesions was omitted as other studies did not confirm the benefit of this methodology [15]. …”

Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma

“…Up to two target lesions (selected in order of maximum baseline diameter to represent the entire tumor burden) in the liver were assessed using uni-dimensional measurements for mRECIST according to previous investigations regarding the "optimal number of target lesions" for mRECIST in HCC treated TACE [25,26]. For target lesions, tumor response was quantitatively defined as complete response (CR), indicated by complete disappearance of viable lesions, or partial response (PR), defined as ≥30% decrease from baseline.…”

New Data Supporting Modified RECIST (mRECIST) for Hepatocellular Carcinoma

“…The main open question is whether the use of the mRECIST viable tumor concept for target lesion measurements can bring ORR back as a surrogate for survival. Several clinical trials from investigators around the globe have suggested that this is indeed the case in patients receiving tumor-directed therapies (1,(3)(4)(5). In patients treated with TACE, mRE-CIST ORR of 32% to 57% were observed, with significant correlation between response and overall survival (3,5).…”

“…In this issue of Clinical Cancer Research, Kim and colleagues (1) show that the assessment of tumor response by modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria (2) predicts overall survival in patients with hepatocellular carcinoma (HCC) treated by transcatheter arterial chemoembolization (TACE). The study confirms the results of several recent investigations conducted in the United States, Europe, and Asia (3)(4)(5).…”