Quantitative imaging features of pretreatment CT predict volumetric response to chemotherapy in patients with colorectal liver metastases
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This study investigates whether quantitative image analysis of pretreatment CT scans can predict volumetric response to chemotherapy for patients with colorectal liver metastases (CRLM).
Patients treated with chemotherapy for CRLM (hepatic artery infusion (HAI) combined with systemic or systemic alone) were included in the study. Patients were imaged at baseline and approximately 8 weeks after treatment. Response was measured as the percentage change in tumour volume from baseline. Quantitative imaging features were derived from the index hepatic tumour on pretreatment CT, and features statistically significant on univariate analysis were included in a linear regression model to predict volumetric response. The regression model was constructed from 70% of data, while 30% were reserved for testing. Test data were input into the trained model. Model performance was evaluated with mean absolute prediction error (MAPE) and R2. Clinicopatholologic factors were assessed for correlation with response.
157 patients were included, split into training (n = 110) and validation (n = 47) sets. MAPE from the multivariate linear regression model was 16.5% (R2 = 0.774) and 21.5% in the training and validation sets, respectively. Stratified by HAI utilisation, MAPE in the validation set was 19.6% for HAI and 25.1% for systemic chemotherapy alone. Clinical factors associated with differences in median tumour response were treatment strategy, systemic chemotherapy regimen, age and KRAS mutation status (p < 0.05).
Quantitative imaging features extracted from pretreatment CT are promising predictors of volumetric response to chemotherapy in patients with CRLM. Pretreatment predictors of response have the potential to better select patients for specific therapies.
• Colorectal liver metastases (CRLM) are downsized with chemotherapy but predicting the patients that will respond to chemotherapy is currently not possible.
• Heterogeneity and enhancement patterns of CRLM can be measured with quantitative imaging.
• Prediction model constructed that predicts volumetric response with 20% error suggesting that quantitative imaging holds promise to better select patients for specific treatments.
KeywordsColorectal neoplasms Multidetector computed tomography Liver Prognosis Models, statistical
Angle co-occurrence matrix
Colorectal liver metastases
Clinical risk score
Early tumour shrinkage
Grey-level co-occurrence matrix
Hepatic artery infusion
Local binary pattern
Mean absolute prediction error
Response Evaluation Criteria in Solid Tumours
This study has received funding by NIH/NCI P30 CA008748 Cancer Center Support Grant and the Society for Memorial Sloan Kettering.
Compliance with ethical standards
The scientific guarantor of this publication is Amber L. Simpson, PhD.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Mithat Gonen, PhD kindly provided statistical advice for this manuscript.
Written informed consent was waived by the institutional review board.
Institutional review board approval was obtained.
• performed at one institution
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