Computed Tomography RECIST Assessment of Histopathologic Response and Prediction of Survival in Patients with Resectable Non–Small-Cell Lung Cancer after Neoadjuvant Chemotherapy

Abstract

Introduction This study’s objectives were to determine whether tumor response measured by CT and evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) correlated with overall survival (OS) in patients with non-small cell lung cancer (NSCLC) after neoadjuvant chemotherapy and surgical resection. Methods We measured primary tumor size on CT before and after neoadjuvant chemotherapy in 160 NSCLC patients who underwent surgical resection. The relationship between CT-measured response (RECIST) and histopathologic response (≤10% viable tumor) and OS were assessed by Kaplan Meier survival, univariable and multivariable Cox proportional hazards regression. Results There was a statistically significant association between CT-measured response (RECIST) and OS (p=0.03). However, histopathologic response was a stronger predictor of OS (p=0.002), with a more pronounced separation of the survival curves when compared to CT-measured response. In multivariable Cox regression analysis, only pathologic stage and histopathologic response were significant predictors of OS. A 41% overall discordance rate was noted between CT RECIST response and histopathologic response. CT RECIST classified as non-responders a subset of patients with histopathologic response (8/30 pts, 27%) who demonstrated prolonged survival after neoadjuvant chemotherapy. Conclusion We were unable to show that CT RECIST is a reliable predictor of OS in patients with NSCLC undergoing surgical resection after neoadjuvant chemotherapy. The failure of CT RECIST to predict long-term outcome may be due to the inability of CT imaging to consistently identify patients with histopathologic response. CT RECIST may have only a limited role as an efficacy endpoint after neoadjuvant chemotherapy in patients with resectable NSCLC.

Detection of circulating tumor cells in pulmonary venous blood for resectable non‑small cell lung cancer

“…The pathological result revealed that the majority of patients had >80% of residual tumor, but the patient whose tumor size was 3.0 cm with only 20% of residual tumor had no CTCs or CTM in his PV blood. Previous studies have reported that the percentage of viable tumor cells is a significant predictor of overall survival and disease-free survival in patients with neoadjuvant-treated NSCLC, but not in patients who undergo surgery alone (23,24). It can be hypothesized that the neoadjuvant chemotherapy-mediated inhibition of tumor cell metastatic characteristics and changes in the percentage of tumor cells in primary disease reduces CTC shedding into the blood during surgery.…”

Manual Contouring Based Volumetric Evaluation for Colorectal Cancer with Liver Limited Metastases: A Comparison with RECIST

“…Evaluation of the metastatic liver nodules after treatment including chemotherapy is of crucial importance which can certainly lead us to earlier and more effective salvage treatment in an attempt to prolong survival. Response Evaluation Criteria in Solid Tumours (RECIST) has become the most frequently used response criteria for solid tumours (William et al, 2013). Nevertheless, there are shortcomings and criticism regarding its use in a number of clinical circumstances such as gastrointestinal stromal tumor (GIST) which has created inevitable inter-observer variability and non-reproducible judgments (Yankelevitz et al, 2000;Reeves et al, 2007;Heussel CP et al, 2007;Benjamin et al, 2007;Plathow et al, 2008;Mantatzis et al, 2009;Galizia et al, 2011).…”

“…As RECIST is primarily based on measurement of the longest diameters of the target lesions in the transverse section, it is often a clinical dilemma for radiologists to determine the longest diameters when the target lesions merge to form a conglomerate mass or split into even smaller lesions after treatment (Sohaib et al, 2000;Reiner et al, 2009). Instead, volumetric evaluation (VE) has gained a wider interest and acceptance as an alternative assessment method (Yankelevitz et al, 2000;Winer et al, 2003;Lemke et al, 2006;Vogl et al, 2008;Gavrielides et al, 2009;Frauenfelder et al, 2011;Galizia et al, 2011). An important theoretical advantage of VE is that it offers more accurate measurement and reflection of overall tumor burden in an organ which is with less inter-observer variability and better than the mere measurement of the maximum diameters of up to five indicator lesions per organ (Prasad et al, 2002;Tran et al, 2004;Reiner et al, 2009).…”

“…Response Evaluation Criteria in Solid Tumours (RECIST) has become the most frequently used response criteria for solid tumours (William et al, 2013). Nevertheless, there are shortcomings and criticism regarding its use in a number of clinical circumstances such as gastrointestinal stromal tumor (GIST) which has created inevitable inter-observer variability and non-reproducible judgments (Yankelevitz et al, 2000;Reeves et al, 2007;Heussel CP et al, 2007;Benjamin et al, 2007;Plathow et al, 2008;Mantatzis et al, 2009;Galizia et al, 2011). As RECIST is primarily based on measurement of the longest diameters of the target lesions in the transverse section, it is often a clinical dilemma for radiologists to determine the longest diameters when the target lesions merge to form a conglomerate mass or split into even smaller lesions after treatment (Sohaib et al, 2000;Reiner et al, 2009).…”

Predictive value of radiological response rate for pathological response to neoadjuvant chemotherapy and post-cystectomy survival of bladder urothelial cancer

“…In addition to the previous report on MIBC (8), significant association between CT-measured tumor response and OS was observed also in 160 patients with non-small cell lung cancer who received tumor resection following NAC (20). Higher shrinkage, also associated with pathological downstaging as discussed above, facilitates complete resection at RC and also indicates better chemotherapeutic response in the case of post-RC recurrence, both of which seem to contribute to better DSS after RC.…”