Abstract
BackgroundThe European Association for the Study of the Liver (EASL) criteria and the modified Response Evaluation Criteria in Solid Tumors (mRECIST) are currently adopted to evaluate radiological response in patients affected by HCC and treated with loco-regional procedures. Several studies explored the validity of these measurements in predicting survival but definitive data are still lacking.AimTo conduct a systematic review of studies exploring mRECIST and EASL criteria usefulness in predictive radiological response in HCC undergoing loco-regional therapies and their validity in predicting survival.MethodsA comprehensive search of the literature was performed in electronic databases EMBASE, MEDLINE, COCHRANE LIBRARY, ASCO conferences and EASL conferences up to June 10, 2014. Our overall search strategy included terms for HCC, mRECIST, and EASL. Loco-regional procedures included transarterial embolization (TAE), transarterial chemoembolization (TACE) and cryoablation. Inter-method agreement between EASL and mRECIST was assessed using the k coefficient. For each criteria, overall survival was described in responders vs. non-responders patients, considering all target lesions response.ResultsAmong 18 initially found publications, 7 reports including 1357 patients were considered eligible. All studies were published as full-text articles. Proportion of responders according to mRECIST and EASL criteria was 62.4% and 61.3%, respectively. In the pooled population, 1286 agreements were observed between the two methods (kappa statistics 0.928, 95% confidence interval 0.912–0.944). HR for overall survival (responders versus non responders) according to mRECIST and EASL was 0.39 (95% confidence interval 0.26–0.61, p<0.0001) and 0.38 (95% confidence interval 0.24–0.61, p<0.0001), respectively.ConclusionIn this literature-based meta-analysis, mRECIST and EASL criteria showed very good concordance in HCC patients undergoing loco-regional treatments. Objective response according to both criteria confirms a strong prognostic value in terms of overall survival. This prognostic value appears to be very similar between the two criteria.
Highlights
Hepatocellular carcinoma (HCC) represents today the fifth most common cancer diagnosis and the third most common cause of cancer-related deaths [1]
The European Association for the Study of the Liver (EASL) criteria and the modified Response Evaluation Criteria in Solid Tumors are currently adopted to evaluate radiological response in patients affected by HCC and treated with loco-regional procedures
Proportion of responders according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) and EASL criteria was 62.4% and 61.3%, respectively
Summary
Hepatocellular carcinoma (HCC) represents today the fifth most common cancer diagnosis and the third most common cause of cancer-related deaths [1]. Conventional response evaluation criteria (WHO, World Health Organization and RECIST, Response Evaluation Criteria in Solid Tumors) have shown poor correlation with survival outcome in HCC patients, since they do not address measures of antitumor activity other than tumour shrinkage (which is based on the sum of bidimensional measurements of target lesions) [8]. To overcome this limitation, a modification of the response assessment was developed starting from 2001 in order to include the concept of tumour viability (tumoral tissue showing arterial uptake in the arterial phase of contrast-enhanced imaging techniques) and discriminate treatment efficacy from early failure [6]. Several studies explored the validity of these measurements in predicting survival but definitive data are still lacking
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