Imaging response in the primary index lesion and clinical outcomes following transarterial locoregional therapy for hepatocellular carcinoma

Ahsun Riaz, Frank H. Miller, Laura M. Kulik, Paul Nikolaidis, Vahid Yaghmai, Robert J. Lewandowski, Mary F. Mulcahy, Robert K. Ryu, Kent T. Sato, Ramona Gupta, Ed Wang, Talia Baker, Michael Abecassis, Al B. Benson, Albert A. Nemcek, Reed Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

Context: Response Evaluation Criteria in Solid Tumors (RECIST) (unidimensional), World Health Organization (WHO) (bidimensional), and European Association for Study of the Liver (EASL) (necrosis) guidelines are commonly used to assess response following therapy for hepatocellular carcinoma (HCC). No universally accepted standard exists. Objectives: To evaluate intermethod agreement between these 3 imaging guidelines and to introduce the concept of the "primary index lesion" as a biomarker for response. Design, Setting, and Participants: Single-center comprehensive imaging analysis including 245 consecutive patients with HCC who were treated with chemoembolization or radioembolization between January 2000 and December 2008. Computed tomography and magnetic resonance imaging scans (N=1065) were reviewed to assess response in the "primary index lesion," defined as the largest tumor targeted during first treatment. Main Outcome Measures: Intermethod agreement (κ statistics) between RECIST, WHO, and EASL guidelines response; correlation of WHO and EASL response in the primary index lesion with time to progression and survival. Results: κ Coefficients were 0.86 (95% confidence interval [CI], 0.80-0.92) between the WHO and RECIST guidelines, 0.24 (95% CI, 0.16-0.33) between RECIST and EASL, and 0.28 (95% CI, 0.19-0.36) between WHO and EASL. Disease progressed in 96 patients; 113 died. The hazard ratio for time to progression in responders compared with nonresponders was 0.36 (95% CI, 0.23-0.57) for WHO, 0.38 (95% CI, 0.24-0.58) for RECIST, and 0.38 (95% CI, 0.22-0.64) for EASL. Hazard ratios for survival in responders compared with nonresponders in univariate and multivariate analyses were 0.46 (95% CI, 0.32-0.67) and 0.55 (95% CI, 0.35-0.84) for WHO and 0.36 (95% CI, 0.22-0.57) and 0.54 (95% CI, 0.34-0.85) for EASL. Hazard ratios for survival in responders vs nonresponders in patients with solitary and multifocal HCC were 0.39 (95% CI, 0.19-0.77) and 0.51 (95% CI, 0.32-0.82) forWHOand 0.26 (95% CI, 0.10-0.67) and 0.47 (95% CI, 0.28-0.79) for EASL. Conclusions: Among a group of patients with HCC, agreement for classification of therapeutic response was high between the RECIST and WHO guidelines but low between each of these and EASL. Application of these methods to measure response in a primary index lesion resulted in statistically significant correlations with disease progression and survival.

Original languageEnglish (US)
Pages (from-to)1062-1069
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume303
Issue number11
DOIs
StatePublished - Mar 17 2010

Fingerprint

Hepatocellular Carcinoma
Confidence Intervals
Liver
Therapeutics
Guidelines
Survival
Disease Progression
Response Evaluation Criteria in Solid Tumors
Necrosis
Multivariate Analysis
Biomarkers
Tomography
Magnetic Resonance Imaging
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{443845b74a5242eeb3e04c310be7c253,
title = "Imaging response in the primary index lesion and clinical outcomes following transarterial locoregional therapy for hepatocellular carcinoma",
abstract = "Context: Response Evaluation Criteria in Solid Tumors (RECIST) (unidimensional), World Health Organization (WHO) (bidimensional), and European Association for Study of the Liver (EASL) (necrosis) guidelines are commonly used to assess response following therapy for hepatocellular carcinoma (HCC). No universally accepted standard exists. Objectives: To evaluate intermethod agreement between these 3 imaging guidelines and to introduce the concept of the {"}primary index lesion{"} as a biomarker for response. Design, Setting, and Participants: Single-center comprehensive imaging analysis including 245 consecutive patients with HCC who were treated with chemoembolization or radioembolization between January 2000 and December 2008. Computed tomography and magnetic resonance imaging scans (N=1065) were reviewed to assess response in the {"}primary index lesion,{"} defined as the largest tumor targeted during first treatment. Main Outcome Measures: Intermethod agreement (κ statistics) between RECIST, WHO, and EASL guidelines response; correlation of WHO and EASL response in the primary index lesion with time to progression and survival. Results: κ Coefficients were 0.86 (95{\%} confidence interval [CI], 0.80-0.92) between the WHO and RECIST guidelines, 0.24 (95{\%} CI, 0.16-0.33) between RECIST and EASL, and 0.28 (95{\%} CI, 0.19-0.36) between WHO and EASL. Disease progressed in 96 patients; 113 died. The hazard ratio for time to progression in responders compared with nonresponders was 0.36 (95{\%} CI, 0.23-0.57) for WHO, 0.38 (95{\%} CI, 0.24-0.58) for RECIST, and 0.38 (95{\%} CI, 0.22-0.64) for EASL. Hazard ratios for survival in responders compared with nonresponders in univariate and multivariate analyses were 0.46 (95{\%} CI, 0.32-0.67) and 0.55 (95{\%} CI, 0.35-0.84) for WHO and 0.36 (95{\%} CI, 0.22-0.57) and 0.54 (95{\%} CI, 0.34-0.85) for EASL. Hazard ratios for survival in responders vs nonresponders in patients with solitary and multifocal HCC were 0.39 (95{\%} CI, 0.19-0.77) and 0.51 (95{\%} CI, 0.32-0.82) forWHOand 0.26 (95{\%} CI, 0.10-0.67) and 0.47 (95{\%} CI, 0.28-0.79) for EASL. Conclusions: Among a group of patients with HCC, agreement for classification of therapeutic response was high between the RECIST and WHO guidelines but low between each of these and EASL. Application of these methods to measure response in a primary index lesion resulted in statistically significant correlations with disease progression and survival.",
author = "Ahsun Riaz and Miller, {Frank H.} and Kulik, {Laura M.} and Paul Nikolaidis and Vahid Yaghmai and Lewandowski, {Robert J.} and Mulcahy, {Mary F.} and Ryu, {Robert K.} and Sato, {Kent T.} and Ramona Gupta and Ed Wang and Talia Baker and Michael Abecassis and Benson, {Al B.} and Nemcek, {Albert A.} and Reed Omary and Riad Salem",
year = "2010",
month = "3",
day = "17",
doi = "10.1001/jama.2010.262",
language = "English (US)",
volume = "303",
pages = "1062--1069",
journal = "JAMA - Journal of the American Medical Association",
issn = "0098-7484",
publisher = "American Medical Association",
number = "11",

}

TY - JOUR

T1 - Imaging response in the primary index lesion and clinical outcomes following transarterial locoregional therapy for hepatocellular carcinoma

AU - Riaz, Ahsun

AU - Miller, Frank H.

AU - Kulik, Laura M.

AU - Nikolaidis, Paul

AU - Yaghmai, Vahid

AU - Lewandowski, Robert J.

AU - Mulcahy, Mary F.

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Gupta, Ramona

AU - Wang, Ed

AU - Baker, Talia

AU - Abecassis, Michael

AU - Benson, Al B.

AU - Nemcek, Albert A.

AU - Omary, Reed

AU - Salem, Riad

PY - 2010/3/17

Y1 - 2010/3/17

N2 - Context: Response Evaluation Criteria in Solid Tumors (RECIST) (unidimensional), World Health Organization (WHO) (bidimensional), and European Association for Study of the Liver (EASL) (necrosis) guidelines are commonly used to assess response following therapy for hepatocellular carcinoma (HCC). No universally accepted standard exists. Objectives: To evaluate intermethod agreement between these 3 imaging guidelines and to introduce the concept of the "primary index lesion" as a biomarker for response. Design, Setting, and Participants: Single-center comprehensive imaging analysis including 245 consecutive patients with HCC who were treated with chemoembolization or radioembolization between January 2000 and December 2008. Computed tomography and magnetic resonance imaging scans (N=1065) were reviewed to assess response in the "primary index lesion," defined as the largest tumor targeted during first treatment. Main Outcome Measures: Intermethod agreement (κ statistics) between RECIST, WHO, and EASL guidelines response; correlation of WHO and EASL response in the primary index lesion with time to progression and survival. Results: κ Coefficients were 0.86 (95% confidence interval [CI], 0.80-0.92) between the WHO and RECIST guidelines, 0.24 (95% CI, 0.16-0.33) between RECIST and EASL, and 0.28 (95% CI, 0.19-0.36) between WHO and EASL. Disease progressed in 96 patients; 113 died. The hazard ratio for time to progression in responders compared with nonresponders was 0.36 (95% CI, 0.23-0.57) for WHO, 0.38 (95% CI, 0.24-0.58) for RECIST, and 0.38 (95% CI, 0.22-0.64) for EASL. Hazard ratios for survival in responders compared with nonresponders in univariate and multivariate analyses were 0.46 (95% CI, 0.32-0.67) and 0.55 (95% CI, 0.35-0.84) for WHO and 0.36 (95% CI, 0.22-0.57) and 0.54 (95% CI, 0.34-0.85) for EASL. Hazard ratios for survival in responders vs nonresponders in patients with solitary and multifocal HCC were 0.39 (95% CI, 0.19-0.77) and 0.51 (95% CI, 0.32-0.82) forWHOand 0.26 (95% CI, 0.10-0.67) and 0.47 (95% CI, 0.28-0.79) for EASL. Conclusions: Among a group of patients with HCC, agreement for classification of therapeutic response was high between the RECIST and WHO guidelines but low between each of these and EASL. Application of these methods to measure response in a primary index lesion resulted in statistically significant correlations with disease progression and survival.

AB - Context: Response Evaluation Criteria in Solid Tumors (RECIST) (unidimensional), World Health Organization (WHO) (bidimensional), and European Association for Study of the Liver (EASL) (necrosis) guidelines are commonly used to assess response following therapy for hepatocellular carcinoma (HCC). No universally accepted standard exists. Objectives: To evaluate intermethod agreement between these 3 imaging guidelines and to introduce the concept of the "primary index lesion" as a biomarker for response. Design, Setting, and Participants: Single-center comprehensive imaging analysis including 245 consecutive patients with HCC who were treated with chemoembolization or radioembolization between January 2000 and December 2008. Computed tomography and magnetic resonance imaging scans (N=1065) were reviewed to assess response in the "primary index lesion," defined as the largest tumor targeted during first treatment. Main Outcome Measures: Intermethod agreement (κ statistics) between RECIST, WHO, and EASL guidelines response; correlation of WHO and EASL response in the primary index lesion with time to progression and survival. Results: κ Coefficients were 0.86 (95% confidence interval [CI], 0.80-0.92) between the WHO and RECIST guidelines, 0.24 (95% CI, 0.16-0.33) between RECIST and EASL, and 0.28 (95% CI, 0.19-0.36) between WHO and EASL. Disease progressed in 96 patients; 113 died. The hazard ratio for time to progression in responders compared with nonresponders was 0.36 (95% CI, 0.23-0.57) for WHO, 0.38 (95% CI, 0.24-0.58) for RECIST, and 0.38 (95% CI, 0.22-0.64) for EASL. Hazard ratios for survival in responders compared with nonresponders in univariate and multivariate analyses were 0.46 (95% CI, 0.32-0.67) and 0.55 (95% CI, 0.35-0.84) for WHO and 0.36 (95% CI, 0.22-0.57) and 0.54 (95% CI, 0.34-0.85) for EASL. Hazard ratios for survival in responders vs nonresponders in patients with solitary and multifocal HCC were 0.39 (95% CI, 0.19-0.77) and 0.51 (95% CI, 0.32-0.82) forWHOand 0.26 (95% CI, 0.10-0.67) and 0.47 (95% CI, 0.28-0.79) for EASL. Conclusions: Among a group of patients with HCC, agreement for classification of therapeutic response was high between the RECIST and WHO guidelines but low between each of these and EASL. Application of these methods to measure response in a primary index lesion resulted in statistically significant correlations with disease progression and survival.

UR - http://www.scopus.com/inward/record.url?scp=77949494089&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77949494089&partnerID=8YFLogxK

U2 - 10.1001/jama.2010.262

DO - 10.1001/jama.2010.262

M3 - Article

C2 - 20233824

AN - SCOPUS:77949494089

VL - 303

SP - 1062

EP - 1069

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0098-7484

IS - 11

ER -