Interobserver Variability in CT-based Morphologic Tumor Response Assessment of Colorectal Liver Metastases

Nina J Wesdorp; Ruby Kemna; Karen Bolhuis; Jan H T M van Waesberghe; Irene M G C Nota; Femke Struik; Ikrame Oulad Abdennabi; Saffire S K S Phoa; Susan van Dieren; Martinus J van Amerongen; Thiery Chapelle; Cornelis H C Dejong; Marc R W Engelbrecht; Michael F Gerhards; Dirk Grünhagen; Thomas M van Gulik; John J Hermans; Koert P de Jong; Joost M Klaase; Mike S L Liem; Krijn P van Lienden; I Quintus Molenaar; Gijs A Patijn; Arjen M Rijken; Theo M Ruers; Cornelis Verhoef; Johannes H W de Wilt; Rutger-Jan Swijnenburg; Cornelis J A Punt; Joost Huiskens; Jaap Stoker; Geert Kazemier; Dutch Colorectal Liver Expert Panel

doi:10.1148/rycan.210105

Interobserver Variability in CT-based Morphologic Tumor Response Assessment of Colorectal Liver Metastases

Radiol Imaging Cancer. 2022 May;4(3):e210105. doi: 10.1148/rycan.210105.

Authors

Nina J Wesdorp^#¹, Ruby Kemna^#¹, Karen Bolhuis¹, Jan H T M van Waesberghe¹, Irene M G C Nota¹, Femke Struik¹, Ikrame Oulad Abdennabi¹, Saffire S K S Phoa¹, Susan van Dieren¹, Martinus J van Amerongen¹, Thiery Chapelle¹, Cornelis H C Dejong¹, Marc R W Engelbrecht¹, Michael F Gerhards¹, Dirk Grünhagen¹, Thomas M van Gulik¹, John J Hermans¹, Koert P de Jong¹, Joost M Klaase¹, Mike S L Liem¹, Krijn P van Lienden¹, I Quintus Molenaar¹, Gijs A Patijn¹, Arjen M Rijken¹, Theo M Ruers¹, Cornelis Verhoef¹, Johannes H W de Wilt¹, Rutger-Jan Swijnenburg¹, Cornelis J A Punt¹, Joost Huiskens¹, Jaap Stoker^#¹, Geert Kazemier^#¹; Dutch Colorectal Liver Expert Panel¹

Affiliation

¹ From the Department of Surgery (N.J.W., R.K., G.K.) and Department of Radiology and Nuclear Medicine (J.H.T.M.v.W., I.M.G.C.N., F.S., I.O.A., S.S.K.S.P., M.R.W.E., J.S.), Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Medical Oncology (K.B., C.J.A.P.) and Department of Surgery (S.v.D., T.M.v.G., R.J.S.), Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands (M.J.v.A., J.J.H.); Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium (T.C.); Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands (C.H.C.D.); Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany (C.H.C.D.); Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands (M.F.G.); Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (D.G., C.V.); Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands (K.P.d.J., J.M.K.); Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands (M.S.L.L.); Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands (K.P.v.L.); Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St Antonius Hospital, Nieuwegein, the Netherlands (I.Q.M.); Department of Surgery, Isala Hospital, Zwolle, the Netherlands (G.A.P.); Department of Surgery, Amphia Hospital, Breda, the Netherlands (A.M.R.); Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.M.R.); Department of Surgery, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands (J.H.W.d.W.); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (C.J.A.P.); and Department of Health, SAS Institute, Huizen, the Netherlands (J.H.).

^# Contributed equally.

Abstract

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 κ. 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 (κ = 0.53, 95% CI: 0.48, 0.58 and κ = 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. Keywords: Tumor Response, Observer Performance, CT, Liver, Metastases, Oncology, Abdomen/Gastrointestinal Clinical trial registration no. NCT02162563 Supplemental material is available for this article. © RSNA, 2022.

Keywords: Abdomen/Gastrointestinal; CT; Liver; Metastases; Observer Performance; Oncology; Tumor Response.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Colorectal Neoplasms* / diagnostic imaging
Colorectal Neoplasms* / genetics
Female
Humans
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / drug therapy
Liver Neoplasms* / genetics
Male
Middle Aged
Observer Variation
Prospective Studies
Tomography, X-Ray Computed / methods

Associated data

ClinicalTrials.gov/NCT02162563