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Abstract
Purpose
The aim of this study was to compare the measurements of diameter and volume of hepatic metastases from CT images with the overall survival and tumor response, in patients with unresectable liver metastases of colorectal cancer treated with a targeted agent.
Materials and Methods
We recruited 43 patients with unresectable liver metastases of colorectal cancer, in whom targeted therapy was used as the first-line treatment. Three-dimensional quantification of the volume of hepatic metastases was performed for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors guidelines was performed and compared to the volumetric measurement. Overall survival was evaluated using the Kaplan-Meier analysis and compared to the Cox proportional hazard ratios (HRs) following univariate and multivariate analyses.
Results
In patients classified as non-progressing and progressing by the volumetric criteria, the median overall survival time was 21 months [95% confidence interval (CI): 491.25–768.75] and 11 months (95% CI: 0–949.42), respectively (p = 0.001). Using a multivariate analysis, we found that volumetric response (HR: 3.467;p = 0.002) was a significant factor affecting the overall survival in patients with liver metastases of colorectal cancer.
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Fig. 1.
Example images of the volumetric measurement of liver metastases using the semiautomated quantification technique. A, B. For tumor margin segmentation, ROIs were manually drawn on two or three slices showing a well-delineated tumor (arrow at A). The entire tumor volume was calculated automatically (arrow at B) based on the attenuation of the drawn ROI in Hounsfield units. C, D. Example of the non-progressing group based on the volumetric criteria. CLM in a 43-year-old man is shown, with the baseline and first follow-up CT images obtained in the portal venous phase in a patient with CLM treated with bevacizumab plus FOLFIRI. At the baseline, the tumor volume was 2.7 cm3 in the left lobe of the liver (arrow at C). After the treatment, the tumor volume slightly decreased and was 2.0 cm3 (26% reduction in the total volume of the target lesion arrow at D). E, F. Example of the progressing group based on the volumetric criteria. CLM in a 47-year-old woman is shown, with the baseline and first follow-up CT images obtained in the portal venous phase in a patient with CLM treated with bevacizumab plus FOLFIRI. At the baseline, the tumor volume was 22 cm3 in the right posterior section of the liver (arrow at E). After the treatment, the tumor volume increased and was 47 cm3 (113% increase in the total volume of the target lesion; arrow at F). CLM = colorectal liver metastasis, FOLFIRI = folinic acid, fluorouracil, and irinotecan, ROI = region of interest
Fig. 2.
Kaplan–Meier analyses with the log-rank test to compare the overall survival in (A) the progressing and non-progressing groups based on the volumetric criteria and (B) based on the RECIST version 1.1, and in (C) the responder and non-responder groups based on the volumetric criteria and (D) based on the RE-CIST version 1.1. The median overall survival in the non-progressing group (21 months) based on the volumetric criteria was longer than that in the progressing group (11 months;p = 0.001; Log-rank test). There were no statistically significant differences in the overall survival between the progressing and non-progressing groups according to the RECIST 1.1 or between the responder and non-responder groups according to the volumetric criteria and RECIST 1.1. RECIST = Response Evaluation Criteria in Solid Tumors
Table 1.
Baseline Patient Characteristics
Table 2.
Cross-Tabulation of RECIST and Volumetric Criteria Response to Treatment
| Volumetric Criteria | RECIST Criteria | ||||
|---|---|---|---|---|---|
| (n = 43) | CR | PR | SD | PD | Total |
| CR | 0 | 0 | 0 | 0 | 0 |
| PR | 0 | 4 | 5 | 0 | 9 |
| PR SD | 0 0 | 4 1 | 5 24 | 0 0 | 9 25 |
| PD | 0 | 0 | 3 | 6 | 9 |
| Total | 0 | 5 | 32 | 6 | 43 |
Table 3.
Prognostic Factors Affecting Survival Based on Univariate Analysis
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