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Metabolic response evaluation for colorectal liver metastases and correlation to pathologic response and tumour markers
Author(s) -
Lau Lawrence F.,
Murone Carmel,
Williams David S.,
Standish Richard,
Lee Sze Ting,
Christophi Christopher,
Scott Andrew M.,
Muralidharan Vijayaragavan
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13680
Subject(s) - medicine , grading (engineering) , colorectal cancer , positron emission tomography , proportional hazards model , gdf15 , oncology , receiver operating characteristic , chemotherapy , pathology , cancer , nuclear medicine , civil engineering , engineering
Background Tumour metabolic response to chemotherapy is increasingly recognized as a prognostic indicator for colorectal cancer liver metastases ( CRCLM ). However, its clinical role and the underlying biological mechanism of its prognostic ability are unclear. This study compares metabolic to pathologic response for CRCLM , and correlates metabolic response to tumour expression of six key biomarkers. Methods Thirty‐seven patients who had positron emission tomography imaging before and after pre‐operative chemotherapy prior to liver resection for CRCLM were included. Metabolic response was assessed according to the positron emission tomography response criteria in solid tumours ( PERCIST ) and correlated to recurrence‐free and overall survival. PERCIST was compared to tumour regression grading, computed tomography (CT) response, tumour necrosis and mucin and immunohistochemical expression of Ki‐67, hypoxia inducible factor 1α, vascular endothelial growth factor, p53, p16 and vimentin. Area under the receiver operating characteristic curve ( AUC ), Kaplan–Meier survival, Spearman's correlation ( r s ) and multivariate Cox regression analyses were used. Results PERCIST correlated significantly to 2‐year mortality ( AUC = 0.162, P < 0.01) and 2‐year recurrence ( AUC = 0.284, P = 0.03). Metabolically responsive tumours conferred a better overall survival ( P = 0.01) and recurrence‐free survival ( P = 0.03). Tumour regression grading did not stratify for outcome. Metabolic response was significantly correlated to Ki‐67 and p16 expression ( r s = 0.559 and r s = −0.549, respectively). Multivariate analysis revealed only PERCIST to be correlated to death and recurrence. Conclusion Pre‐operative PERCIST assessment of CRCLM was more prognostic than pathologic and CT response assessment. Metabolic non‐response correlated with tumour proliferation and loss of tumour suppression.