title: Response Evaluation Criteria in Solid Tumors (RECIST) criteria are superior to European Association for Study of the Liver (EASL) criteria at 1 month follow-up for predicting long-term survival in patients treated with transarterial chemoembolization before liver transplantation for hepatocellular cancer.
abstract: OBJECTIVE
  To determine whether response to transarterial chemoembolization can predict survival in patients with hepatocellular carcinoma (HCC) who are candidates for orthotopic liver transplantation (LT) and if either European Association for Study of the Liver (EASL) criteria or Response Evaluation Criteria in Solid Tumors (RECIST) criteria are more accurate for this purpose.
  
  
  METHODS
  A retrospective review of all patients who underwent LT after transarterial chemoembolization between January 2005 and June 2011 was performed. Follow-up imaging with multiphasic computed tomography or magnetic resonance imaging was performed 1 month after transarterial chemoembolization and every 3 months thereafter until LT. Treatment response was evaluated at each imaging time point using RECIST criteria and EASL criteria. The relationship between survival and objective response (OR), time to response (TTR), time to progression (TTP), and time interval between transarterial chemoembolization and LT was assessed.
  
  
  RESULTS
  A median of one transarterial chemoembolization procedure was performed before LT in 58 patients (52 men, 6 women; mean age, 57 y). OR was shown by 28 (48%) patients and 51 (88%) patients at 1 month by EASL criteria and RECIST criteria, respectively. OR at 1-month follow-up using RECIST criteria was associated with increased survival compared with patients with no response (NR) (P = .03). Using RECIST criteria, 5-year survival in the OR group was 66.7% versus 0% in the NR group (P = .015). There was no significant difference in survival in patients who showed OR at 1 month using EASL criteria. There was poor agreement between RECIST and EASL response assessments (κ = 0.23). There was no significant association between survival and TTR, TTP, or time interval between transarterial chemoembolization and LT.
  
  
  CONCLUSIONS
  Patients with objective response to transarterial chemoembolization at 1 month using RECIST criteria showed improved survival over nonresponders. RECIST criteria demonstrated better accuracy compared with EASL criteria for predicting survival in patients after LT who had transarterial chemoembolization as a "bridge."
authors.affiliation: Department of Medical Imaging, Division of Vascular/Interventional Radiology, University Health Network & Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto, ON M5G 1X5, Canada. tshuster2000@yahoo.com
authors.forename: Anatoly
authors.initials: A
authors.lastname: Shuster
authors.forename: Thien J
authors.initials: TJ
authors.lastname: Huynh
authors.forename: Dheeraj K
authors.initials: DK
authors.lastname: Rajan
authors.forename: Max A
authors.initials: MA
authors.lastname: Marquez
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
authors.forename: Dan C
authors.initials: DC
authors.lastname: Huynh
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Jaskolka
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D003131:Combined Modality Therapy / Q000401:mortality; D005060:Europe; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016031:Liver Transplantation / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011300:Preoperative Care; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents