International Journal of Clinical Oncology

, Volume 24, Issue 11, pp 1397–1405 | Cite as

Comparison of computed tomography imaging analyses for evaluation after chemotherapy in patients with colorectal cancer: a retrospective pooled analysis of six phase II clinical trials

  • Kosuke Hirose
  • Eiji OkiEmail author
  • Takayuki Shimose
  • Sanae Sakamoto
  • Shun Sasaki
  • Tomoko Jogo
  • Qingjiang Hu
  • Yasuo Tsuda
  • Koji Ando
  • Yuichiro Nakashima
  • Hiroshi Saeki
  • Masaki Mori
Original Article



There are several methods for analyzing computed tomography (CT) images to evaluate chemotherapy efficacy in clinical studies. However, the optimal analysis method for each drug is still under debate. We conducted a pooled analysis using data from six phase II studies to evaluate four analysis methods in colorectal cancers (CRCs): morphological responses (MRs), early tumor shrinkage (ETS), depth of response (DpR), and response evaluation criteria in solid tumors (RECIST) ver.1.1.


We included 249 patients in this analysis. Pretreatments and findings of subsequent CT imaging were analyzed based on the MR, ETS, DpR, and RECIST ver.1.1. Differences in overall survival (OS) between the responders and non-responders according to each method were evaluated using survival analysis.


The responders had significantly better hazard ratios (HRs) for OS, in terms of DpR (≥ median), ETS, objective response rate (ORR) [complete response (CR) + partial response (PR)], and disease control rate [CR + PR + stable disease (SD)]. Patients with right-sided colon cancers showed better HRs for DpR, but not for ETS and ORR. Contrastingly, patients with left-sided CRCs had better HRs for ETS, DpR, and ORR. MR was not associated with outcomes in this study, even in cases where bevacizumab was used. In patients with liver metastasis, ETS, DpR, and ORR showed better HRs, but not in those with lung metastasis.


Early tumor shrinkage and DpR might be predictive markers only in left-sided CRCs with liver metastasis. Each imaging analysis has a different value based on the primary and metastatic sites.


Colorectal cancer Early tumor shrinkage Morphologic response Deepness of response Primary location Clinical trial 



We thank for the following institutions and investigators who participated in this study: Nishimaki T (Ryukyu University Hospital), Natsugoe S (Kagoshima University Hospital), Eguchi S (Nagasaki University Hospital), Akagi Y (Kurume University Hospital), Ogata Y (Kurume University Hospital), Baba H (Kumamoto University Hospital), and Kakeji Y (Kobe University Hospital). We also thank for researcher Sakamoto S and statistician Shimose T at the Clinical Research Support center Kyushu (CReS Kyushu). This study was supported by CReS Kyushu with no funding. We also would like to thank Editage ( for English language editing.

Compliance with ethical standards

Conflict of interest

There are no potential conflicts of interest to disclose.

Supplementary material

10147_2019_1509_MOESM1_ESM.pdf (78 kb)
Supplementary Fig. 1 Forest plots showing the hazard ratios (HRs) for overall survival comparing each evaluation method in the cetuximab-treated subgroup. (PDF 78 kb)
10147_2019_1509_MOESM2_ESM.pdf (81 kb)
Supplementary Fig. 2 Forest plots showing the hazard ratios (HRs) for overall survival comparing each evaluation method in patients including liver metastases. (PDF 80 kb)
10147_2019_1509_MOESM3_ESM.pdf (81 kb)
Supplementary Fig. 3 Forest plots showing the hazard ratios (HRs) for overall survival comparing each evaluation method in patients including lung metastases. (PDF 80 kb)
10147_2019_1509_MOESM4_ESM.pdf (144 kb)
Supplementary file4 (PDF 143 kb)


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Kosuke Hirose
    • 1
  • Eiji Oki
    • 1
    Email author
  • Takayuki Shimose
    • 2
  • Sanae Sakamoto
    • 3
  • Shun Sasaki
    • 1
  • Tomoko Jogo
    • 1
  • Qingjiang Hu
    • 1
  • Yasuo Tsuda
    • 1
  • Koji Ando
    • 1
  • Yuichiro Nakashima
    • 1
  • Hiroshi Saeki
    • 1
  • Masaki Mori
    • 1
  1. 1.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Clinical Research Support Center Kyushu (CReS Kyushu)FukuokaJapan
  3. 3.Kyushu Study Group of Clinical Cancer (KSCC)FukuokaJapan

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