The Modified Response Evaluation Criteria in Solid Tumors (RECIST) Yield a More Accurate Prognoses Than the RECIST 1.1 in Hepatocellular Carcinoma Treated with Transarterial Radioembolization

Abstract

Background/Aims: The Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) criteria have been used to assess treatment responses for hepatocellular carcinoma (HCC) patients. We investigated which criteria provides better survival predictions in HCC patients treated with transarterial radioembolization (TARE). Methods: In total, 102 patients with unresectable intrahepatic HCC, who were treated with TARE between 2012 and 2017, were reviewed retrospectively. The treatment response after TARE was evaluated at 1, 3, and 6 months by the mRE-CIST and RECIST 1.1. Responders were defined as patients with complete or partial responses by each criterion. Results: The median age of 83 men and 19 women was 64.3 years. The median alpha-fetoprotein and des-gamma-carboxy prothrombin levels were 37.1 ng/mL and 1,780.0 mAU/mL, respectively. The median maximal tumor size was 8.3 cm, and multiple tumors were observed in 36 patients (35.3%). During the follow-up period (median, 20.7 months), 21 patients (20.6%) died, with a mean survival time of 55.5 months. The cumulative survival rate was 96.1% at 6 months and 89.3% at 12 months. Responders, defined by the mRECIST at 1, 3, and 6 months after TARE, showed better survival outcomes than nonresponders (hazard ratio [HR]=5.736, p=0.008 at 1 month; HR=3.145, p=0.022 at 3 months, and HR=2.887, p=0.061 at 6 months). The survival rates of responders and nonresponders defined by the RECIST 1.1 were similar (all p>0.05). Conclusions: Response evaluations that use the mRECIST provide more accurate prognoses than those that use the RECIST 1.1 in HCC patients treated with TARE.

Lenvatinib is independently associated with the reduced risk of progressive disease when compared with sorafenib in patients with advanced hepatocellular carcinoma

“…The most important risk factors for HCC are chronic liver disease and cirrhosis, mainly caused by hepatotropic viruses, such as hepatitis B virus (HBV) and hepatitis C virus, and alcohol 2–4 . Only 40% of patients are diagnosed at an early stage of HCC and can be treated with liver resection, surgical therapy, and radiofrequency ablation 5–11 . However, patients who experience recurrent HCC or those with advanced‐stage HCC are not suitable candidates for the above‐mentioned curative treatments 5,12 .…”

“…[2][3][4] Only 40% of patients are diagnosed at an early stage of HCC and can be treated with liver resection, surgical therapy, and radiofrequency ablation. [5][6][7][8][9][10][11] However, patients who experience recurrent HCC or those with advanced-stage HCC are not suitable candidates for the above-mentioned curative treatments. 5,12 Systemic targeted therapies have been shown to extend the survival of patients with unresectable, advanced-stage HCC.…”

Tumor response as defined by iRECIST in gastrointestinal malignancies treated with PD-1 and PD-L1 inhibitors and correlation with survival

“…Therefore, updated criteria have to be used to capture these atypical response patterns in patients treated with cancer immunotherapy to distinguish them from those of traditional cytotoxic chemotherapy and molecular targeted therapy. Therefore, the most commonly used and validated treatment response criteria of conventional chemotherapies in solid tumors, RECIST 1.1 are not capable of properly assessing response after PD-1/PD-L1 inhibitor therapy [ 15 ]. To further improve imaging markers for evaluating the efficacy of PD-1/PD-L1 inhibitor therapy, the consensus guidelines for iRECIST were revised in 2017 [ 16 ].…”

Selecting the Right Tool for the Right Job: Which Response Criteria Better Predicts Survival of Patients Treated with Transarterial Radioembolization?

“…Responders who had a complete response or partial response according to modified RECIST criteria at 1 month or 3 months after TARE exhibited significantly better survival than non-responders. 5 The best response, defined as the most favorable response during the first 6 months after TARE, also predicted longer survival when using modified RECIST criteria.…”

“…In this issue of Gut and Liver , Lee et al . 5 compared the RECIST 1.1 and modified RECIST criteria to predict overall survival in patients with HCC receiving TARE. The modified RECIST criteria successfully predicted better overall survival, whereas the RECIST 1.1 criteria failed to demonstrate any correlation with survival outcomes.…”