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Case Reports
. 2021 Jul;82(4):876-888.
doi: 10.3348/jksr.2020.0085. Epub 2021 Mar 22.

Comparison of CT Volumetry and RECIST to Predict the Treatment Response and Overall Survival in Gastric Cancer Liver Metastases

Sung Hyun Yu, Seung Joon Choi, HeeYeon Noh, In Seon Lee, So Hyun Park, Se Jong Kim
Case Reports

Comparison of CT Volumetry and RECIST to Predict the Treatment Response and Overall Survival in Gastric Cancer Liver Metastases

Sung Hyun Yu et al. Taehan Yongsang Uihakhoe Chi. 2021 Jul.

Abstract
in English, Korean

Purpose: The aim of this study was to compare the diameter and volume of liver metastases on CT images in relation to overall survival and tumor response in patients with gastric cancer liver metastases (GCLM) treated with chemotherapy.

Materials and methods: We recruited 43 patients with GCLM who underwent chemotherapy as a first-line treatment. We performed a three-dimensional quantification of the metastases for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors (RECIST) was performed and compared to volumetric measurements. Overall survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios following univariate analyses.

Results: When patients were classified as responders or non-responders based on volumetric criteria, the median overall survival was 23.6 months [95% confidence interval (CI), 8.63-38.57] and 7.6 months (95% CI, 3.78-11.42), respectively (p = 0.039). The volumetric analysis and RECIST of the non-progressing and progressing groups showed similar results based on the Kaplan-Meier method (p = 0.006) and the Cox proportional hazard model (p = 0.008).

Conclusion: Volumetric assessment of liver metastases could be an alternative predictor of overall survival for patients with GCLM treated with chemotherapy.

목적: 항암 치료를 진행하는 위암 간전이 환자에서 종양의 길이를 이용한 반응 평가와 비교하여 종양의 부피를 이용한 반응 평가가 환자의 생존율을 더 잘 예측할 수 있는지 알아보는 연구이다.

대상과 방법: 항암 치료를 진행하는 위암 간전이 환자 43명을 연구에 포함하였다. 간전이 종양의 부피를 정량적으로 계산한 기준과 Response Evaluation Criteria in Solid Tumors 기준을 비교하였다. 카플란-마이어, 콕스비례위험 모형을 사용하여 일변량분석과 다변량분석을 통해 환자 생존율 및 연관된 인자를 알아보았다.

결과: 저자들은 간전이 종양의 부피를 정량적으로 계산한 기준을 이용했을 때, 질환 반응군(23.6개월; 95% 신뢰구간, 8.63~38.57)과 질환 비반응군(7.6개월; 95% 신뢰구간, 3.78~11.42)간 생존율에 통계학적 유의한 차이를 확인하였다(p = 0.039). 질환 안정군과 질환 진행군을 부피를 이용한 반응 평가와 길이를 이용한 반응 평가로 구분할 경우 양군은 생존기간과 위험비에서 의미 있는 차이를 보였으나 두 반응 평가 방법 간 차이는 없었다(카플란-마이어 모형: p = 0.006; 콕스비례위험 모형: 위험비, 2.437,p = 0.008).

결론: 항암 치료를 진행하는 위암 간전이 환자들에서 간전이의 부피 반응 평가는 환자들의 생존율을 예측하는 데 도움을 줄 수 있다.

Keywords: Chemotherapy; Gastric Cancer; Liver Neoplasm; Survival.

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Conflict of interest statement

Conflicts of Interest: The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Images of volumetric measurements of liver metastases using the semiautomated quantification technique.
A–F. A case of gastric cancer liver metastases of partial response based on volumetric criteria in a 57-year-old male, with baseline and first follow-up CT images obtained in the portal venous phase. Free-hand drawn images before three-dimensional volumetric reconstruction, arrows at baseline (A) and post-treatment (B). At baseline, the tumor volume was 24 cm3 in the right lobe of the liver (arrow, C). After treatment, the tumor volume decreased to 7 cm3 [71% reduction in the total volume of the target lesion; arrow at (D)]. Based on the RECIST, this patient was diagnosed with stable disease [from 38 to 33 mm, a 13% reduction in the maximal diameter of the target lesion, and arrows at (E), (F)]. G–L. A progression case with gastric cancer liver metastases based on volumetric criteria in a 70-year-old female is shown, with baseline and first follow-up CT images obtained in the portal venous phase. Free-hand drawn images before three-dimensional reconstruction, arrows at baseline (G) and post-treatment (H). At baseline, the tumor volume was 6 cm3 in the left lobe of the liver (arrow, I). After treatment, the tumor volume increased to 15 cm3 [150% increase in the total volume of the target lesion; arrow at (J)]. Based on the RECIST, this patient was diagnosed with stable disease [from 31 to 34 mm, a 9.7 % increase in the maximal diameter of the target lesion, and arrows at (K) and (L)]. RECIST = Response Evaluation Criteria in Solid Tumors
Fig. 2
Fig. 2. Kaplan-Meier analysis with log-rank test to compare overall survival between the responder and non-responder groups according to the volumetric criteria (A) and RECIST 1.1 (B); and between the non-progressing and progressing groups according to the volumetric criteria (C) and RECIST 1.1 (D). The median overall duration of survival of the responders (23.6 months), based on the volumetric criteria, was longer than that of the non-responders (7.6 months, p = 0.039, log-rank test). The outcomes of the volumetric and RECIST analyses were similar in the non-progressing and progressing groups. The median overall duration of survival of the non-progressing group (16.2 months) was longer than that of the progressing group (6.6 months) based on volumetry and RECIST 1.1 (p = 0.006).
RECIST = Response Evaluation Criteria in Solid Tumors
See this image and copyright information in PMC

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