Role of the EASL, RECIST, and WHO response guidelines alone or in combination for hepatocellular carcinoma: Radiologic–pathologic correlation

Abstract

Purpose-We sought to study receiver-operating characteristics (ROC) of the European Association for the Study of the Liver (EASL), Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) guidelines of assessing response following locoregional therapies individually and in various combinations.Methods-Eighty-one patients with hepatocellular carcinoma underwent liver explantation following locoregional therapies. Response was assessed using EASL, RECIST and WHO. Kappa statistics were used to determine inter-method agreement. Uni/multivariate logistic regression analyses were performed to determine the variables predicting complete pathologic necrosis. Numerical values were assigned to the response classes: complete response=0, partial response=1, stable disease=2 and progressive disease=3. Various mathematical combinations of EASL and WHO were tested to calculate scores and their ROCs were studied using pathological examination of the explant as the gold standard.Results-Median times (95% CI) to WHO, RECIST and EASL response were 5.3 (4-11.5), 5.6 (4-11.5) and 1.3 months (1.2-1.5) respectively. Kappa coefficients for WHO/RECIST, WHO/ EASL and RECIST/EASL were 0.78, 0.28 and 0.31 respectively. EASL response demonstrated significant odds ratios for predicting complete pathologic necrosis on uni/multivariate analyses. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

Transarterial Y90 radioembolization versus chemoembolization for patients with hepatocellular carcinoma: A meta-analysis

“…Recently, radiological response rate was assessed according to modified RECIST (5,(39)(40)(41). In El Fouly's study (29), objective response during a median time of 6 months reached disease control in 75% of TARE (Y90) patients vs. 50% in the TACE cohort, which reflects the higher capability of TARE (Y90) to induce tumor necrosis and ablation in vascular HCCs (4).…”

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

“…In addition, mRECIST is a major step forward compared with the previous enhancement method, EASL criteria, in terms that mRECIST not only somewhat simplifies complex EASL criteria, but also provides special recommendations for new lesion and nontarget lesions, such as portal vein thrombosis, lymph node at porta hepatis, ascites, or pleural effusion in detail. EASL and mRECIST guideline have shown superior efficacy for assessing treatment responses and predicting survival outcomes compared with WHO and RECIST guidelines in patients with HCC because enhancement criteria can discriminate patients with better clinical outcomes by tumor necrosis, regardless of shrinkage of entire tumor mass (3,(8)(9)(10)(11)(12).…”

Radiographic Response to Locoregional Therapy in Hepatocellular Carcinoma Predicts Patient Survival Times

“…Radiological tumor response by WHO, RECIST and EASL guidelines have already been established to correlate well with actual pathological necrosis. [17][18][19] Unfortunately, there is a dearth of studies correlating response with survival in aggregate, particularly in HCC. Sala et al performed a study correlating initial 1-month CR to survival in patients treated with ablation.…”