Identifying enhancement-based staging markers on baseline MRI in patients with colorectal cancer liver metastases undergoing intra-arterial tumor therapy.
OBJECTIVES
To determine if three-dimensional whole liver and baseline tumor enhancement features on MRI can serve as staging biomarkers and help predict survival of patients with colorectal cancer liver metastases (CRCLM) more accurately than one-dimensional and non-enhancement-based features.


METHODS
This retrospective study included 88 patients with CRCLM, treated with transarterial chemoembolization or Y90 transarterial radioembolization between 2001 and 2014. Semi-automated segmentations of up to three dominant lesions were performed on pre-treatment MRI to calculate total tumor volume (TTV) and total liver volumes (TLV). Quantitative 3D analysis was performed to calculate enhancing tumor volume (ETV), enhancing tumor burden (ETB, calculated as ETV/TLV), enhancing liver volume (ELV), and enhancing liver burden (ELB, calculated as ELV/TLV). Overall and enhancing tumor diameters were also measured. A modified Kaplan-Meier method was used to determine appropriate cutoff values for each metric. The predictive value of each parameter was assessed by Kaplan-Meier survival curves and univariable and multivariable cox proportional hazard models.


RESULTS
All methods except whole liver (ELB, ELV) and one-dimensional/non-enhancement-based methods were independent predictors of survival. Multivariable analysis showed a HR of 2.1 (95% CI 1.3-3.4, p = 0.004) for enhancing tumor diameter, HR 1.7 (95% CI 1.1-2.8, p = 0.04) for TTV, HR 2.3 (95% CI 1.4-3.9, p < 0.001) for ETV, and HR 2.4 (95% CI 1.4-4.0, p = 0.001) for ETB.


CONCLUSIONS
Tumor enhancement of CRCLM on baseline MRI is strongly associated with patient survival after intra-arterial therapy, suggesting that enhancing tumor volume and enhancing tumor burden are better prognostic indicators than non-enhancement-based and one-dimensional-based markers.


KEY POINTS
• Tumor enhancement of colorectal cancer liver metastases on MRI prior to treatment with intra-arterial therapies is strongly associated with patient survival. • Three-dimensional, enhancement-based imaging biomarkers such as enhancing tumor volume and enhancing tumor burden may serve as the basis of a novel prognostic staging system for patients with liver-dominant colorectal cancer metastases.
['Ghani|Mansur A|MA|', 'Fereydooni|Arash|A|', 'Chen|Evan|E|', 'Letzen|Brian|B|', 'Laage-Gaupp|Fabian|F|', 'Nezami|Nariman|N|', 'Deng|Yanhong|Y|', 'Gan|Geliang|G|', 'Thakur|Vinayak|V|', 'Lin|MingDe|M|', 'Papademetris|Xenophon|X|', 'Schernthaner|Ruediger E|RE|', 'Huber|Steffen|S|', 'Chapiro|Julius|J|http://orcid.org/0000-0002-1984-2246', 'Hong|Kelvin|K|', 'Georgiades|Christos|C|']
D015415:Biomarkers D006528:Carcinoma, Hepatocellular D016461:Chemoembolization, Therapeutic D015179:Colorectal Neoplasms D006801:Humans D008113:Liver Neoplasms D008279:Magnetic Resonance Imaging D012189:Retrospective Studies D047368:Tumor Burden
Colorectal neoplasms Magnetic resonance imaging Neoplasm staging Radiology, interventional Treatment outcome