Quantitative methodology using CT for predicting survival in patients with metastatic colorectal carcinoma: a pilot study

• Published in: Clinical imaging Vol. 34; no. 3; pp. 196 - 202
• Main Authors: Gottlieb, Ronald H, Raczyk, Cheryl, Hanna, Timothy, Fora, Ahmad, Tan, Wei, Nayyar, Rahul, Fakih, Marwan
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2010; Elsevier; Elsevier Limited
• Subjects: Abdomen; Accuracy; Adult; Aged; Aged, 80 and over; Agreements; Biological and medical sciences; Cancer; Cancer therapies; Carcinoma - diagnostic imaging; Carcinoma - mortality; Carcinoma - secondary; Clinical trials; Colorectal Carcinoma; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - mortality; Colorectal Neoplasms - secondary; Computed tomography; Female; Gastroenterology. Liver. Pancreas. Abdomen; Health Insurance Portability & Accountability Act 1996-US; Humans; Male; Mammography; Medical imaging; Medical sciences; Middle Aged; Pilot Projects; Proportional Hazards Models; Quantitative; Radiology; Reproducibility of Results; Risk assessment; Scoring; Sensitivity and Specificity; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Analysis; Survival Rate; Tomography, X-Ray Computed - statistics & numerical data; Tumors; Colorectal Carcinoma; Scoring; Quantitative; Computed tomography; Human; Rectal disease; Radiodiagnosis; Methodology; Colorectal carcinoma; Colorectal cancer; Malignant tumor; Metastasis; Survival; Colonic disease; Medical imagery; Digestive diseases; Intestinal disease; Metastatic; Computerized axial tomography; Cancer; Quantitative analysis
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2010.01.002

Abstract Objective To develop a methodology which quantifies multiple changing lesion features resulting in an optimized computed tomography (CT) response score (CRS) for prediction of overall survival (OS) in response to treatment for metastatic colorectal carcinoma (MCRC). Subjects and Methods This Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective study evaluated multiple changing imaging findings and their correlation with OS with a new methodology comparing the baseline and first post-treatment CT scans in 38 MCRC patients on last-line chemotherapy (cetuximab and irinotecan). Tumor size/enhancement changes and interval development of new lesions were quantified with either Likert-type scales (all parameters) or Response Evaluation Criteria in Solid Tumors (RECIST) (size change only). The most predictive parameters for OS were used to generate the CRS with an overall range of −3 (complete disappearance) to +2 (definite tumor increase). The Cox Hazard Ratio was used to assess prediction of survival. Reader agreement was evaluated by the kappa statistic. Results Tumor size was the best predictor of OS using the Likert-type scale or RECIST. The CRS was not improved combining size change with other parameters. Use of the Likert-type scale resulted in predicting OS with a Cox hazard ratio of 1.697 ( P =.0004) and good agreement (kappa=0.73, 95% CI=0.41–1.10) between observers with no significant difference using RECIST. Conclusion The methodology produces a CRS for MCRC predicting OS resulting from therapy which expands standard RECIST guidelines to allow critical evaluation of multiple additional imaging parameters. Size change alone was found to be the best parameter of those considered in terms of maximizing agreement and prediction of OS.