title: Prognostic Relevance of Objective Response According to EASL Criteria and mRECIST Criteria in Hepatocellular Carcinoma Patients Treated with Loco-Regional Therapies: A Literature-Based Meta-Analysis.
abstract: BACKGROUND
  The 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.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Among 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.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Medical Oncology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vincenzi
authors.affiliation: Clinical Trials Unit, National Cancer Institute, Naples, Italy; Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano (TO), Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Maio
authors.affiliation: Medical Oncology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Silletta
authors.affiliation: Medical Oncology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Loretta
authors.initials: L
authors.lastname: D'Onofrio
authors.affiliation: Medical Oncology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Spoto
authors.affiliation: Clinical Trials Unit, National Cancer Institute, Naples, Italy.
authors.forename: Maria Carmela
authors.initials: MC
authors.lastname: Piccirillo
authors.affiliation: Clinical Trials Unit, National Cancer Institute, Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Daniele
authors.affiliation: Medical Oncology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Comito
authors.affiliation: Medical Oncology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Eliana
authors.initials: E
authors.lastname: Maci
authors.affiliation: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bronte
authors.affiliation: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Russo
authors.affiliation: Medical Oncology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.affiliation: Clinical Trials Unit, National Cancer Institute, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perrone
authors.affiliation: Medical Oncology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tonini
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome