Volumetric Versus Unidimensional Measures of Metastatic Colorectal Cancer in Assessing Disease Response

Abstract

Introduction: The purpose of this study was to compare unidimensional (1D/linear) and volumetric (3D) measures of metastatic colorectal cancer (mCRC) at computed tomography (CT) for predicting clinical outcome.

Patients and methods: Analysis of CT images in 105 patients (mean age, 59 years; range, 25-81 years; 45 women, 60 men) receiving treatment for mCRC was performed. Both unidimensional and volumetric measures were obtained on index lesions at 3 time points (baseline/midpoint/post-therapy; mean interval, 4.1 months; median, 3.7 months) by 3 readers using a semi-automated technique. Measurements were summed and compared using best overall response across the 3 time points. Patient response was categorized based on Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 thresholds for unidimensional and volume measures (CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease). Survival data was correlated (mean follow-up, 19.9 ± 17.1 months; median, 14.7 months). Intra/interobserver variability and reproducibility of 1D and 3D measures was assessed. Cox survival and Kaplan-Meier models were constructed and compared.

Results: Cox models and Kaplan-Meier curves for unidimensional versus volumetric assessment were very similar in appearance. Both 1D and 3D measurements effectively separated PD from the SD/PR groups, but neither separated SD from PR well. Volumetric measures showed comparable intra/interobserver variability on Bland-Altman analysis to unidimensional measures across readers using a semi-automated measurement technique. Metastatic site (lung, liver, node, other) did not seem to impact measurement reproducibility.

Conclusions: Although CT volumetric assessment of metastatic colorectal cancer is fairly reproducible by reader and site using a semi-automated technique, the ability to stratify progressive disease from other disease response categories in terms of survival was similar to unidimensional measurement.

Keywords: Computed tomography; Metastatic colorectal cancer; Response assessment.