Tumour Growth Rate to predict the outcome of patients with Neuroendocrine Tumours: Performance and sources of variability
2020
INTRODUCTION Tumor growth rate (TGR), percentage of change in tumor volume/month, has been previously identified as an early radiological biomarker for treatment monitoring in neuroendocrine tumors (NETs) patients. We assessed the performance and reproducibility of TGR 3 months (TGR3m) as a predictor factor of progression-free survival (PFS), including the impact of imaging method and reader variability. METHODS Baseline and 3-months (±1month) CT/MRI images from patients with advanced, grade 1-2 NETs were retrospectively reviewed by 2 readers. Influence of number of targets, tumor burden and location of lesion on the performance of TGR3m to predict PFS was assessed by uni/multivariable Cox regression analysis. Agreement between readers was assessed by the Lin's concordance coefficient (LCC) and Kappa (KC). RESULTS A total of 790 lesions were measured in 222 patients. Median PFS was 22.9 months. On univariable analysis, number of lesions (≥4), tumor burden and presence of liver metastases were significantly correlated to PFS. On multivariate analysis, ≥4 lesions (HR:1.89 (95%CI:1.01-3.57)), TGR3m ≥0.8%/m (HR:4.01 (95%CI:2.31-6.97)) and watch-and-wait correlated with shorter PFS. No correlation was found between TGR3m and number of lesions (rho:-0.2; p-value:0.1930). No difference in mean TGR3m across organs was shown (p-value:0.6). Concordance between readers was acceptable (LCC:0.52 (95%CI:0.38-0.65); KC:0.57 agreement:81.55%). TGR3m remained a significant prognostic factor when data from second reader was employed (HR:4.35 (95%CI:2.44-7.79); p-value<0.001) and regardless his expertise (HR:1.21 (95%CI:0.70-2.09); p-value:0.493). DISCUSSION/CONCLUSION TGR3m is a robust and early radiological biomarker able to predict PFS. It may be used to identify patients with advanced NETs who require closer radiological follow-up.
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