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

Ahsun Riaz, Khairuddin Memon, Frank H. Miller, Paul Nikolaidis, Laura M. Kulik, Robert J. Lewandowski, Robert K. Ryu, Kent T. Sato, Vanessa L. Gates, Mary F. Mulcahy, Talia Baker, Ed Wang, Ramona Gupta, Ritu Nayar, Al B. Benson, Michael Abecassis, Reed Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Background & Aims: 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 for 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 the WHO, RECIST, and EASL responses 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. Calculated areas under the ROC curves were: RECIST: 0.63, WHO: 0.68, EASL: 0.82, EASL + WHO: 0.82, EASL × WHO: 0.85, EASL + (2 × WHO): 0.79 and (2 × EASL) + WHO: 0.85. An EASL × WHO Score of ≤1 had 90.2% sensitivity for predicting complete pathologic necrosis. Conclusions: The product of WHO and EASL demonstrated better ROC than the individual guidelines for assessment of tumor response. EASL × WHO scoring system provides a simple and clinically applicable method of response assessment following locoregional therapies for hepatocellular carcinoma.

Original languageEnglish (US)
Pages (from-to)695-704
Number of pages10
JournalJournal of Hepatology
Volume54
Issue number4
DOIs
StatePublished - Apr 1 2011

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Hepatocellular Carcinoma
Guidelines
Liver
ROC Curve
Necrosis
Response Evaluation Criteria in Solid Tumors
Therapeutics
Multivariate Analysis
Logistic Models
Odds Ratio
Regression Analysis

Keywords

  • Hepatocellular carcinoma
  • Imaging
  • Locoregional therapies
  • Pathologic correlation

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{bf8fca07193e45a5a6d35fe46a881ff6,
title = "Role of the EASL, RECIST, and WHO response guidelines alone or in combination for hepatocellular carcinoma: Radiologic-pathologic correlation",
abstract = "Background & Aims: 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 for 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 the WHO, RECIST, and EASL responses 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. Calculated areas under the ROC curves were: RECIST: 0.63, WHO: 0.68, EASL: 0.82, EASL + WHO: 0.82, EASL × WHO: 0.85, EASL + (2 × WHO): 0.79 and (2 × EASL) + WHO: 0.85. An EASL × WHO Score of ≤1 had 90.2{\%} sensitivity for predicting complete pathologic necrosis. Conclusions: The product of WHO and EASL demonstrated better ROC than the individual guidelines for assessment of tumor response. EASL × WHO scoring system provides a simple and clinically applicable method of response assessment following locoregional therapies for hepatocellular carcinoma.",
keywords = "Hepatocellular carcinoma, Imaging, Locoregional therapies, Pathologic correlation",
author = "Ahsun Riaz and Khairuddin Memon and Miller, {Frank H.} and Paul Nikolaidis and Kulik, {Laura M.} and Lewandowski, {Robert J.} and Ryu, {Robert K.} and Sato, {Kent T.} and Gates, {Vanessa L.} and Mulcahy, {Mary F.} and Talia Baker and Ed Wang and Ramona Gupta and Ritu Nayar and Benson, {Al B.} and Michael Abecassis and Reed Omary and Riad Salem",
year = "2011",
month = "4",
day = "1",
doi = "10.1016/j.jhep.2010.10.004",
language = "English (US)",
volume = "54",
pages = "695--704",
journal = "Journal of Hepatology",
issn = "0168-8278",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Role of the EASL, RECIST, and WHO response guidelines alone or in combination for hepatocellular carcinoma

T2 - Radiologic-pathologic correlation

AU - Riaz, Ahsun

AU - Memon, Khairuddin

AU - Miller, Frank H.

AU - Nikolaidis, Paul

AU - Kulik, Laura M.

AU - Lewandowski, Robert J.

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Gates, Vanessa L.

AU - Mulcahy, Mary F.

AU - Baker, Talia

AU - Wang, Ed

AU - Gupta, Ramona

AU - Nayar, Ritu

AU - Benson, Al B.

AU - Abecassis, Michael

AU - Omary, Reed

AU - Salem, Riad

PY - 2011/4/1

Y1 - 2011/4/1

N2 - Background & Aims: 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 for 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 the WHO, RECIST, and EASL responses 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. Calculated areas under the ROC curves were: RECIST: 0.63, WHO: 0.68, EASL: 0.82, EASL + WHO: 0.82, EASL × WHO: 0.85, EASL + (2 × WHO): 0.79 and (2 × EASL) + WHO: 0.85. An EASL × WHO Score of ≤1 had 90.2% sensitivity for predicting complete pathologic necrosis. Conclusions: The product of WHO and EASL demonstrated better ROC than the individual guidelines for assessment of tumor response. EASL × WHO scoring system provides a simple and clinically applicable method of response assessment following locoregional therapies for hepatocellular carcinoma.

AB - Background & Aims: 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 for 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 the WHO, RECIST, and EASL responses 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. Calculated areas under the ROC curves were: RECIST: 0.63, WHO: 0.68, EASL: 0.82, EASL + WHO: 0.82, EASL × WHO: 0.85, EASL + (2 × WHO): 0.79 and (2 × EASL) + WHO: 0.85. An EASL × WHO Score of ≤1 had 90.2% sensitivity for predicting complete pathologic necrosis. Conclusions: The product of WHO and EASL demonstrated better ROC than the individual guidelines for assessment of tumor response. EASL × WHO scoring system provides a simple and clinically applicable method of response assessment following locoregional therapies for hepatocellular carcinoma.

KW - Hepatocellular carcinoma

KW - Imaging

KW - Locoregional therapies

KW - Pathologic correlation

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U2 - 10.1016/j.jhep.2010.10.004

DO - 10.1016/j.jhep.2010.10.004

M3 - Article

C2 - 21147504

AN - SCOPUS:79952696628

VL - 54

SP - 695

EP - 704

JO - Journal of Hepatology

JF - Journal of Hepatology

SN - 0168-8278

IS - 4

ER -