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Meta-Analysis
. 2015 Jul 31;10(7):e0133488.
doi: 10.1371/journal.pone.0133488. eCollection 2015.

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

Bruno Vincenzi  1 , Massimo Di Maio  2 , Marianna Silletta  1 , Loretta D'Onofrio  1 , Chiara Spoto  1 , Maria Carmela Piccirillo  3 , Gennaro Daniele  3 , Francesca Comito  1 , Eliana Maci  1 , Giuseppe Bronte  4 , Antonio Russo  4 , Daniele Santini  1 , Francesco Perrone  3 , Giuseppe Tonini  1
Affiliations
Meta-Analysis

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

Bruno Vincenzi et al. PLoS One. .

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.

Aim: 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.

Conclusion: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of study selection.
Fig 2
Fig 2. Forest plot for HR for overall survival (responders vs non responders) according to mRECIST criteria.
Fig 3
Fig 3. Forest plot for HR for overall survival (responders vs non responders) according to EASL criteria.
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