Analysis of Response Evaluation Criteria in Solid Tumors reduction ratio of primary chemotherapy in unresectable advanced or recurrent colorectal cancer.

Shiho Kawagoe,Eishi Baba,Koji Ikejiri,Tatsuhiro Kajitani,Kohei Arimizu,Keita Uchino,Tetsuya Kusumoto,Masahiro Nakano,Hozumi Shimokawa

doi:10.3892/mco.2019.1894

Abstract

Response Evaluation Criteria in Solid Tumors (RECIST) is used to assess the objective response of solid tumors to treatment. However, it remains unclear to what extent the response rate assessed by RECIST reflects a reduction of tumor size in multiple organs in patients with unresectable advanced or recurrent colorectal cancer (CRC) with multiple organ metastases. It is also unclear whether the management of liver metastases with systemic chemotherapy in CRC patients with multiple organ metastases improves their prognosis, although surgical resection has been shown to be the most effective treatment approach to CRC cases with liver metastases. A total of 38 CRC patients who underwent systemic chemotherapy in Kyushu Medical Center Hospital between January 2013 and April 2016 were examined. The patients had measurable lesions in multiple organs, including the liver, and did not undergo curative surgery for metastatic lesions after initiation of chemotherapy. The association between the total reduction ratio (TRR) of all lesions and liver lesion reduction ratio (LRR) was retrospectively analyzed. A total of 18 patients (47%) had H3 liver metastases, and the median liver lesion occupancy rate in the sum of the measured lesions with RECIST was 76%. TRR and LRR were strongly correlated, regardless of the volume of the liver metastases. Although a TRR of >30% was significantly associated with improved overall survival (OS), this improvement was not observed in patients with H3 liver metastases. TRR was correlated with LRR and was associated with a better OS. CRC patients with both multiple organ and H3 liver metastases exhibited poor survival, even with a high reduction ratio by chemotherapy.

Highlights

Colorectal cancer (CRC) is the third most common malignancy and the fourth leading cause of cancer‐related mortality worldwide [1,2]
Controlling liver metastases is an important factor for improving overall survival (OS) in CRC patients with limited liver metastases, as several studies have demonstrated that the resection of liver metastases led to a better prognosis compared with hepatectomy after chemotherapy [18,19,20,21,22]
The aim of the present study was to investigate CRC cases with multiple organ metastases, including the liver, in order to analyze how the total reduction ratio (TRR) is correlated with the lesion reduction ratio (LRR) and to evaluate whether tumor reduction and the control of liver metastases with systemic chemotherapy can improve patient prognosis

Summary

Introduction

Colorectal cancer (CRC) is the third most common malignancy and the fourth leading cause of cancer‐related mortality worldwide [1,2]. A randomized phase 3 trial (First‐Line Treatment For Patients With Metastatic Colorectal Cancer‐3) examining first‐line chemotherapy for mCRC demonstrated that the depth of response (DpR) was correlated with survival time [16]. Controlling liver metastases is an important factor for improving OS in CRC patients with limited liver metastases, as several studies have demonstrated that the resection of liver metastases led to a better prognosis compared with hepatectomy after chemotherapy [18,19,20,21,22]. Regardless of recurrence in the liver or extrahepatic organs following hepatectomy, hepatectomized patients had a significantly better prognosis compared with patients not undergoing resection [22,24,25,26,27]. The Japanese Society for Cancer of the Colon and Rectum 2014 guidelines for the treatment of CRC recommend surgical resection of liver metastases when the liver lesions become resectable following

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