TY - JOUR
T1 - Interobserver Variability in CT-based Morphologic Tumor Response Assessment of Colorectal Liver Metastases
AU - Dutch Colorectal Liver Expert Panel
AU - Wesdorp, Nina J
AU - Kemna, Ruby
AU - Bolhuis, Karen
AU - van Waesberghe, Jan H T M
AU - Nota, Irene M G C
AU - Struik, Femke
AU - Oulad Abdennabi, Ikrame
AU - Phoa, Saffire S K S
AU - van Dieren, Susan
AU - van Amerongen, Martinus J
AU - Chapelle, Thiery
AU - Dejong, Cornelis H C
AU - Engelbrecht, Marc R W
AU - Gerhards, Michael F
AU - Grünhagen, Dirk
AU - van Gulik, Thomas M
AU - Hermans, John J
AU - de Jong, Koert P
AU - Klaase, Joost M
AU - Liem, Mike S L
AU - van Lienden, Krijn P
AU - Molenaar, I Quintus
AU - Patijn, Gijs A
AU - Rijken, Arjen M
AU - Ruers, Theo M
AU - Verhoef, Cornelis
AU - de Wilt, Johannes H W
AU - Swijnenburg, Rutger-Jan
AU - Punt, Cornelis J A
AU - Huiskens, Joost
AU - Stoker, Jaap
AU - Kazemier, Geert
N1 - Funding Information: The CAIRO5 study is supported in part by unrestricted scientific grants from Roche and Amgen. The current study is supported in part by an unrestricted grant from the Cancer Center Amsterdam Foundation. Funding Information: Disclosures of conflicts of interest: N.J.W. The CAIRO5 study is supported by unrestricted scientific grants from Roche and Amgen. Current study is supported by an unrestricted grant from the Cancer Center Amsterdam Foundation. The funders had no role in the design, conduct, analysis of the study, writing of the manuscript, nor in the decision to submit the manuscript for publication. R.K. No relevant relationships. K.B. No relevant relationships. J.H.T.M.v.W. No relevant relationships. I.M.G.C.N. No relevant relationships. F.S. No relevant relationships. I.O.A. No relevant relationships. S.S.K.S.P. No relevant relationships. S.v.D. No relevant relationships. M.J.v.A. No relevant relationships. T.C. No relevant relationships. C.H.C.D. No relevant relationships. M.R.W.E. No relevant relationships. M.F.G. No relevant relationships. D.G. No relevant relationships. T.M.v.G. No relevant relationships. J.J.H. Consulting fees to Amsterdam University Medical Center (reader of the study) (payments were made to the Radboud University Medical Center). K.P.d.J. No relevant relationships. J.M.K. Prehabilitation outpatient clinic educational grant 2019 (Johnson and Johnson grant 20K and 24K to UMCG); preha-bilitation implementation grant 2021 (Johnson and Johnson grant 30K to UMCG/ NvVH); prehabiltation implementation grant 2021 (Viphor Pharma grant 20K to UMCG); member of several committees of the NVvH (prehabilitation working group, audit working group, Dutch Society of Surgery). M.S.L.L. No relevant relationships. K.P.v.L. No relevant relationships. I.Q.M. No relevant relationships. G.A.P. No relevant relationships. A.R.M. No relevant relationships. T.M.R. No relevant relationships. C.V. No relevant relationships. J.H.W.d.W. Grants from Dutch Cancer Society, ZonMW, Roche, Covidien, and Bergh in het zadel Foundation. R.J.S. No relevant relationships. C.J.A.P. Advisory role for Nordic Pharma. J.H. No relevant relationships. J.S. Vice President of European Society of Gastrointestinal and Abdominal Radiology (unpaid). G.K. SAS Analytics provided expertise and technical support; traveling expenses from SAS Analytics. Publisher Copyright: © RSNA, 2022.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Purpose: To evaluate interobserver variability in the morphologic tumor response assessment of colorectal liver metastases (CRLM) managed with systemic therapy and to assess the relation of morphologic response with gene mutation status, targeted therapy, and Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 measurements. Materials and Methods: Participants with initially unresectable CRLM receiving different systemic therapy regimens from the randomized, controlled CAIRO5 trial (NCT02162563) were included in this prospective imaging study. Three radiologists independently assessed morphologic tumor response on baseline and first follow-up CT scans according to previously published criteria. Two additional radiologists evaluated disagreement cases. Interobserver agreement was calculated by using Fleiss k. On the basis of the majority of individual radiologic assessments, the final morphologic tumor response was determined. Finally, the relation of morphologic tumor response and clinical prognostic parameters was assessed. Results: In total, 153 participants (median age, 63 years [IQR, 56–71]; 101 men) with 306 CT scans comprising 2192 CRLM were included. Morphologic assessment performed by the three radiologists yielded 86 (56%) agreement cases and 67 (44%) disagreement cases (including four major disagreement cases). Overall interobserver agreement between the panel radiologists on morphology groups and morphologic response categories was moderate (k = 0.53, 95% CI: 0.48, 0.58 and k = 0.54, 95% CI: 0.47, 0.60). Optimal morphologic response was particularly observed in patients treated with bevacizumab (P =.001) and in patients with RAS/BRAF mutation (P =.04). No evidence of a relationship between RECIST 1.1 and morphologic response was found (P =.61). Conclusion: Morphologic tumor response assessment following systemic therapy in participants with CRLM demonstrated considerable interobserver variability.
AB - Purpose: To evaluate interobserver variability in the morphologic tumor response assessment of colorectal liver metastases (CRLM) managed with systemic therapy and to assess the relation of morphologic response with gene mutation status, targeted therapy, and Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 measurements. Materials and Methods: Participants with initially unresectable CRLM receiving different systemic therapy regimens from the randomized, controlled CAIRO5 trial (NCT02162563) were included in this prospective imaging study. Three radiologists independently assessed morphologic tumor response on baseline and first follow-up CT scans according to previously published criteria. Two additional radiologists evaluated disagreement cases. Interobserver agreement was calculated by using Fleiss k. On the basis of the majority of individual radiologic assessments, the final morphologic tumor response was determined. Finally, the relation of morphologic tumor response and clinical prognostic parameters was assessed. Results: In total, 153 participants (median age, 63 years [IQR, 56–71]; 101 men) with 306 CT scans comprising 2192 CRLM were included. Morphologic assessment performed by the three radiologists yielded 86 (56%) agreement cases and 67 (44%) disagreement cases (including four major disagreement cases). Overall interobserver agreement between the panel radiologists on morphology groups and morphologic response categories was moderate (k = 0.53, 95% CI: 0.48, 0.58 and k = 0.54, 95% CI: 0.47, 0.60). Optimal morphologic response was particularly observed in patients treated with bevacizumab (P =.001) and in patients with RAS/BRAF mutation (P =.04). No evidence of a relationship between RECIST 1.1 and morphologic response was found (P =.61). Conclusion: Morphologic tumor response assessment following systemic therapy in participants with CRLM demonstrated considerable interobserver variability.
KW - Abdomen/Gastrointestinal
KW - CT
KW - Liver
KW - Metastases
KW - Observer Performance
KW - Oncology
KW - Tumor Response
UR - http://www.scopus.com/inward/record.url?scp=85131835921&partnerID=8YFLogxK
U2 - https://doi.org/10.1148/rycan.210105
DO - https://doi.org/10.1148/rycan.210105
M3 - Article
C2 - 35522139
SN - 2638-616X
VL - 4
SP - e210105
JO - Radiology: Imaging Cancer
JF - Radiology: Imaging Cancer
IS - 3
M1 - e210105
ER -