Which Response Criteria Best Help Predict Survival of Patients with Hepatocellular Carcinoma Following Chemoembolization? A Validation Study of Old and New Models

Abstract

Purpose:To identify differences in radiologic assessment methods and determine optimal imaging criteria for response evaluation in hepatocellular carcinoma (HCC) patients treated with chemoembolization . Materials and Methods:Institutional review board approval was obtained, and patient informed consent was waived. The present study included 332 patients with intermediate stage HCC and Child-Pugh A cirrhosis who underwent serial chemoembolization. All measurable target lesions of 1 cm or larger in diameter were uni-and bidimensionally measured both at baseline and during follow-up. Intermodel agreement among the guidelines of the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), the European Association for the Study of the Liver (EASL), and modifi ed RECIST (mRECIST) were examined. The most reliable model was selected on the basis of the correlation with survival prediction. Results:The k values of comparisons among WHO, RECIST, and mRECIST guidelines were less than 0.20, whereas the k value for the comparison of EASL and mRECIST guidelines was 0.94. In patients with a partial response (PR), stable disease (SD), or progressive disease (PD), compared with patients with a complete response (CR), hazard ratios (HRs) for survival were 2.99 (95% confi dence interval [CI]: 2.14, 4.17), 3.49 (95% CI: 1.71, 7.10), and 15.63 (95% CI: 9.51, 25.69), respectively, for EASL criteria. In patients with a PR, SD, or PD, compared with patients with a CR, the HRs were 2.75 (95% CI: 1.96, 3.87), 6.32 (95% CI: 3.67, 10.90), and 16.06 (95% CI: 9.76, 26.43), respectively, for mRECIST guidelines ( P , .001). The C index for the multivariate model was 0.76 (95% CI: 0.72, 0.79) for both EASL and mRECIST guidelines, thus exhibiting satisfactory capability to help predict survival. The Cox regression model revealed that both mRECIST and EASL guidelines were independent predictors of overall survival ( P , .001 for both). Conclusion:The enhancement models more accurately helped predict long-term survival in HCC patients treated with chemoembolization.q RSNA, 2011

The ART of decision making: Retreatment with transarterial chemoembolization in patients with hepatocellular carcinoma

“…Although the prognostic performance of EASL criteria in the setting of TACE seems to be equal to the performance of mRECIST criteria, 25 the latter may be more adequate to dissect the prognosis of patients with partial response from that of subjects with stable disease. 26 This could rely on a different definition of partial response in the two models: greater than 50% tumor reduction for EASL and greater than 30% for mRECIST criteria. Given that radiologic response is a parameter of the ART score, there is a need for prospective studies validating the ART score which include mRECIST criteria to the study design.…”

Chemoembolization for Hepatocellular Carcinoma

“…19 Tumor response measured by mRECIST after TACE has been shown to correlate with survival outcomes. 20,21 The recent Clinical Practice Guidelines jointly issued by the European Association for the Study of the Liver (EASL) and the European Organization for Research and Treatment of Cancer (EORTC) state that assessment of response in HCC should be based on mRECIST criteria by performing contrast-enhanced CT or MRI 4 weeks after initial treatment. 7 …”

Image-Guided Therapies for Hepatocellular Carcinoma in Hepatocelluar Carcinoma — Future Outlook

“…The concept of achieving complete necrosis (complete response) after LRT is a good surrogate for excellent outcome and has been confirmed by a number of different studies [57][58][59][60].…”

“…Therefore, a new proposal suggested for assessing therapy response for HCC was made by the modification of the conventional RECIST criteria with the incorporation of the concept of viable tumor ( Figure 2). These criteria, also known as the modified RECIST (mRECIST) [63], have been demonstrated to be an accurate tool for assessing response for both locoregional and systemic therapies [59,60,64] and should be used as the method of choice for assessing treatment response in patients with HCC [2]. Although mRECIST helps to predict survival outcomes in patients undergoing LRTs, further data are needed to establish these criteria for assessing survival in the setting of systemic therapies with molecularly targeted drugs.…”