Reproducibility of mRECIST in assessing response to transarterial radioembolization therapy in hepatocellular carcinoma

Abstract

The purpose of our study was to evaluate the reproducibility of Modified Response Evaluation Criteria in Solid Tumors (mRECIST) in hepatocellular carcinoma (HCC) lesions undergoing transarterial radioembolization (TARE) therapy and to determine whether mRECIST reproducibility is affected by the enhancement pattern of HCC. One hundred and three HCC lesions from 103 patients treated with TARE were evaluated. The single longest diameter of viable tumor tissue was measured by two radiologists at baseline; response to therapy was evaluated according to mRECIST. The enhancement pattern of HCC lesions was correlated with their mRECIST response. The response rate between mRECIST and RECIST 1.1 was compared. Wilcoxon signed-rank test, paired t test, Lin's concordance correlation coefficient (q c ), Bland-Altman plot, kappa statistics, and Fisher's exact test were used to assess intra-and interobserver reproducibilities and to compare response rates. There were better intra-than interobserver agreements in the measurement of single longest diameter of viable tumor tissue (bias 5 0 cm intraobserver versus bias 5 0.3 cm interobserver). For mRECIST, good intraobserver (OE 5 0.70) and moderate interobserver (OE 5 0.56) agreements were noted. The mRECIST response for HCC lesions with homogeneous enhancement at both baseline and follow-up imaging showed better intra-and interobserver agreements (OE 5 0.77 and 0.60, respectively) than lesions with heterogeneous enhancement at both scans (OE 5 0.54 and 0.40, respectively). In the early follow-up period mRECIST showed a significantly higher response rate than RECIST (40.8% versus 3.9%; P 5 0.025). Conclusions: In HCC patients treated with TARE, mRE-CIST captures a significantly higher response rate compared with RECIST; it also demonstrates acceptable intra-and interobserver reproducibilities for HCC lesions treated with TARE, and mRECIST reproducibility may be lower for HCC lesions with heterogeneous distribution of the viable tumor tissue. (HEPATOLOGY 2015;62:1111-1121

A multicentre comparison between Child Pugh and Albumin‐Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma

“…Using only two variables, ALBI might be less prone to such coding‐related errors. However, despite these miscoding of CP scores, the concordance between provided and calculated CP scores remained excellent with a kappa at 0.90, which is superior than kappa obtained for inter‐observer variability judged acceptable in radiological evaluation, in the range of 0.50–0.60 .…”

Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma

“…Investigators have highlighted the pitfall of using early enhancement pattern in assessing response for Y90 in large lesions. 31 cTACE is embolic and hence, the vascularity that permits enhancement during cross sectional imaging (arterial hypervascularity) is occluded by the drug/embolic. Y90, on the other hand, is a microembolic therapy that does not occlude the vasculature.…”

Reproducibility of European Association for the Study of the Liver criteria and modified Response Evaluation Criteria in Solid Tumors in patients treated with sorafenib

“…First, our study population consisted mostly of patients treated with sorafenib, which may not represent the entire spectrum of HCC stages with varying treatment modalities. However, because the reproducibility of enhancement‐based criteria has already been validated in patients treated with locoregional therapy such as TACE and 90 Yttrium, our study investigating systemic targeted therapy may fill a gap by determining the interpretational reproducibility of the EASLc and mRECIST. Second, because we focused on the cross‐sectional reproducibility of enhancement‐based criteria based on a small sample, we were unable to determine long‐term outcomes according to treatment response assessed by 2 observers.…”