title: Role of the EASL, RECIST, and WHO response guidelines alone or in combination for hepatocellular carcinoma: radiologic-pathologic correlation.
abstract: OBJECTIVE
  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 1.3months (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.
authors.affiliation: Department of Radiology, Northwestern University, Chicago IL, USA.
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Paul
authors.initials: P
authors.lastname: Nikolaidis
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Ed
authors.initials: E
authors.lastname: Wang
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.forename: Ritu
authors.initials: R
authors.lastname: Nayar
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Reed
authors.initials: R
authors.lastname: Omary
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D005060:Europe; D005260:Female; D006801:Humans; D007390:International Agencies; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012372:ROC Curve; D011859:Radiography; D014944:World Health Organization