Prognostic value of different CT measurements in early therapy response evaluation in patients with metastatic colorectal cancer

Abstract

Objectives: Patients with advanced stage colorectal carcinoma (CRC) display hepatic metastases on initial staging in up to 20% of cases. The effectiveness of chemotherapy is generally evaluated by computed tomography (CT) imaging using standardized criteria (RECIST). However, RECIST is not always optimal, and other criteria have been shown to correlate with pathologic response and overall survival. The aim of this study was to evaluate the prognostic value of different CT measurement for response assessment after initiation of chemotherapy in patients with synchronous colorectal cancer liver metastases. Methods: Fifty-five patients with CRC and synchronous hepatic metastases were evaluated retrospectively at 2 academic centers. Different size, volume, ratio and attenuation parameters were determined at baseline and after 3 cycles of chemotherapy. The prognostic value of baseline measurements and of the change between baseline and second measurements was analyzed using KaplanMeier estimates. Results: Median time to progression was 279 days, median overall survival was 704 days. In this selective patient population, neither a significant prognostic value of initial baseline CT parameters nor a prognostic value of the change between the first and the second CT measurements was found. Conclusion: Initial morphological response assessment using different CT measurements has no prognostic value concerning time to progression or overall survival in patients with synchronous colorectal liver metastases.

Tumor histopathology predicts outcomes after resection of colorectal cancer liver metastases treated with and without pre-operative chemotherapy

“…Yet RECIST response was not correlated with overall survival after liver resection or among unresectable patients after treatment with first-line chemotherapy with bevacizumab. Similarly, RECIST response to FOLFIRI and bevacizumab was not associated with progression free or overall survival after liver resection or in patients with unresectable liver metastases [15,16]. Analysis of the large LiverMet Survey registry revealed 5-year actuarial overall and recurrence free survival among patients with radiologically stable disease after pre-operative chemotherapy of 46% and 20%, respectively [17].…”

Advanced imaging to predict response to chemotherapy in colorectal liver metastases – a systematic review

“…Of these 45 articles, 29 were excluded, leaving 16 articles for inclusion. 10,11,[43][44][45][46][47][48][49][50][51][52][53][54][55][56] More information on the excluded articles and the reason for exclusion is available in the supplementary data.…”

“…Of the included studies, 12/16 studies had a low risk of selection bias. 10,11,44,45,47,48,[50][51][52][54][55][56] Selection bias was introduced in four studies due to unclear enrolment or inappropriate exclusions. 11,43,46,53 The most encountered quality issue concerned the reference standard (RECIST) and its blinding.…”

“…11,43,46,53 The most encountered quality issue concerned the reference standard (RECIST) and its blinding. 10,11,[43][44][45][46]49,50,52,55,56 There were no concerns regarding index test and reference standard applicability. Results of the quality assessment with the QUADAS-2 checklist are available as supplementary data.…”

“…Of the 16 articles included, 11 studied a single modality 10,43,45,46,[48][49][50][51][52]54,55 and 5 studies compared two modalities. 11,44,47,53,56 In total, 5 articles studied FDG-PET, 11,44,50,53,56 1 article studied the FDG-PET-CT, 47 6 articles studied CT 43,[45][46][47]51,53 and 9 articles studied MRI. 10,11,44,48,49,52,[54][55][56] The number of patients ranged from 10 to 145 patients per study, with a total of 560 patients evaluated in all studies.…”