RECIST 1.1 versus mRECIST for assessment of tumour response to molecular targeted therapies and disease outcomes in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

ObjectivesResponse Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1) and modified RECIST (mRECIST) are commonly used to assess tumour response. Which one is better to evaluate efficacy after molecular targeted therapies in hepatocellular carcinoma (HCC) patients is still controversial. A systemic review was performed to compare the objective response rate (ORR) and disease control rate (DCR) and a meta-analysis was conducted to compare the correlation between objective response and overall survival (OS).DesignSystematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach.Data sourcesEMBASE, PubMed, Web of Science and Cochrane Library were searched through 31 December 2021.Eligibility criteriaWe included studies assessing the efficacy of molecular targeted therapy for HCC according to both RECIST 1.1 and mRECIST.Data extraction and synthesisTwo investigators extracted data independently. The consistency between RECIST 1.1 vs mRECIST is measured by the k coefficient. HRs with corresponding 95% CIs were used for meta-analysis.Results23 studies comprising 2574 patients were included in systematic review. The ORR according to mRECIST is higher than RECIST1.1 (15.9% vs 7.8%, p<0.001). The DCR is similar (68.4% vs 67.2%, p=0.5). The agreement of tumour response is moderate for objective response (k=0.499) and perfect for progressive disease (k=0.901), calculated from 8 studies including 372 patients. OS was significantly longer in response group than non-response group according to mRECIST (HR 0.56, 95% CI 0.41 to 0.78, p=0.0004) calculated from 7 studies including 566 patients, however, the RECIST1.1 could not distinguish the OS well (HR 0.68, 95% CI 0.44 to 1.05, p=0.08). Subgroup analusis by type of treatment was conducted.ConclusionsmRECIST may be more accurate than RECIST 1.1 in assessing ORR after molecular targeted therapies in HCC patients and can better assess the prognosis. However, the performance of both criteria in assessing disease progression is identical.PROSPERO registration numberCRD42020200895.Ethics approvalEthics approval is not required in this meta-analysis.

Radiographic and serologic response in patients with unresectable hepatocellular carcinoma receiving systemic antineoplastic treatments: A trial‐level analysis

“…64 In addition, with the newer criteria, a prognostic relationship was identified between patients who had a response and those who had stable disease. 65,66 These changes were also evident in the current analysis, which confirmed the increased response rates using mRECIST criteria compared with RECIST (35% vs. 13%). Conversely, however, the reproducibility of mRECIST is lower, and their usefulness in clinical practice remains limited because they add nothing to the definition of progression.…”

“…The evolution from RECIST criteria to newer radiologic re‐evaluation criteria (mRECIST, Choi, European Association for the Study of the Liver) has been an improvement in response assessment because the percentage of cases with response has increased and that of cases with stable disease has decreased 64 . In addition, with the newer criteria, a prognostic relationship was identified between patients who had a response and those who had stable disease 65,66 . These changes were also evident in the current analysis, which confirmed the increased response rates using mRECIST criteria compared with RECIST (35% vs. 13%).…”

“…Conversely, however, the reproducibility of mRECIST is lower, and their usefulness in clinical practice remains limited because they add nothing to the definition of progression. 66 Future evolution of radiographic evaluation criteria after systemic therapy will need to include additional imaging-related variables, which may overcome the reproducibility limitations of the mRECIST criteria. However, in current studies, it is be important to report both ORRs according to RECIST 1.1 and those obtained with other criteria.…”

“…These changes were also evident in the current analysis, which confirmed the increased response rates using mRECIST criteria compared with RECIST (35% vs. 13%). Conversely, however, the reproducibility of mRECIST is lower, and their usefulness in clinical practice remains limited because they add nothing to the definition of progression 66 . Future evolution of radiographic evaluation criteria after systemic therapy will need to include additional imaging‐related variables, which may overcome the reproducibility limitations of the mRECIST criteria.…”

A Comparison of the Outcomes of Transarterial Chemoembolization and Transarterial Radioembolization in the Management of Neuroendocrine Liver Metastases in Adults: A Systematic Review

“…The RECIST 1.1 guidelines assessed the radiological response to treatment. mRECIST is considered more accurate than RECIST 1.1 ([ 30 ]), but both are equally effective in monitoring disease progression. We used RECIST 1.1 because it was available in most of the studies under review.…”