title: Comparison of tumor response assessment methods in patients with metastatic colorectal cancer after locoregional therapy.
abstract: BACKGROUND
  We evaluated the performance of the Response Evaluation Criteria in Solid Tumor (RECIST), modified RECIST, and the European Association for the Study of Liver (EASL) guidelines and correlated them with survival in patients with metastatic colorectal cancer (mCRC) treated with locoregional therapy (LRT).
  
  
  METHODS
  Our LRT registry was evaluated from 2008 to 2013. 228 mCRC patients were treated with LRT (91% drug-eluting beads, 9% radioembolization) were evaluated. Cox regression and Kaplan-Meier (KM) statistics were utilized for survival analysis.
  
  
  RESULTS
  Excellent inter-rater agreement between EASL/mRECIST (κ = 905) was seen. Correlations between RECIST/mRECIST (κ = 0.638) and EASL/RECIST were weaker (κ = 0.638 and 0.598, respectively). There were significant differences in KM and Cox regression survivals between responders and nonresponders with all three methods (all P < 0.0001). Multivariate analysis identified RECIST response, tumor extent, performance status, concomitant chemotherapy, and prior surgery/ablation as independent prognostic factors. EASL response and mRECIST response were not found to be independent prognostic factors.
  
  
  CONCLUSIONS
  Imaging biomarkers are not efficient and do not represent ideal surrogates for survival; however, they all display prognostic significance. RECIST is superior to mRECIST/EASL given its ability to stratify survival benefit according to response category and demonstrate independent prognostic significance. J. Surg. Oncol. 2016;113:443-448. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiovascular and Interventional Radiology - The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Olaguoke
authors.initials: O
authors.lastname: Akinwande
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Prejesh
authors.initials: P
authors.lastname: Philips
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.affiliation: Department of Radiology, Norton Healthcare, Louisville, Kentucky.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kelly
authors.affiliation: Department of Radiology, Norton Healthcare, Louisville, Kentucky.
authors.forename: Cliff
authors.initials: C
authors.lastname: Tatum
authors.affiliation: Department of Radiation Oncology, Norton Cancer Institute, Louisville, Kentucky.
authors.forename: Mike
authors.initials: M
authors.lastname: Hahl
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D004317:Doxorubicin / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D000077146:Irinotecan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
chemical_list: D014408:Biomarkers, Tumor; D015021:Yttrium Radioisotopes; D000077146:Irinotecan; D004317:Doxorubicin; D002166:Camptothecin
keywords: DEBIRI; EASL; RECIST; chemoembolization; colorectal; mRECIST; metastasis