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Publications

Journal Article Ahead of print 6 citations

PubMed: 40960802 DOI: 10.1001/jamasurg.2025.3600

Diagnostic Accuracy of Imaging in Assessing Nonviability of Disappearing Colorectal Liver Metastasis.

JAMA Surg

Authors: Kozo Kataoka, Murielle Mauer, Manabu Shiozawa, Sandrine Marreaud, Yoji Kishi, Jedelyn Cabrieto, Hiroaki Onaya, Michel Ducreux, Takeshi Suto, Hyunseon Christine Kang, Nobuhisa Matsuhashi, Alice Fung, Masayoshi Yasui, Michel Rivoire, Toru Tonooka, Roberto Ivan Troisi, Kenichi Nakamura, Stefan Stättner, Yusuke Kinugasa, Wai Chin Foo, Grégoire Desolneux, Benjamin Bonhomme, Masataka Ikeda, Carmela Caballero, Florian Lordick, Yukihide Kanemitsu, Serge Evrard

Affiliations

  • Division of Lower Gastrointestinal Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya Japan.
  • European Organisation For Research And Treatment Of Cancer Headquarters, Brussels, Belgium.
  • Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
  • Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
  • Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, Nagoya, Japan.
  • Service d'Oncologie digestive, Université Paris-Saclay, Gustave Roussy, Villejuif, France.
  • Department of Surgery, Yamagata Prefectural Hospital, Yamagata, Japan.
  • Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston.
  • Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Hospital, Gifu, Japan.
  • Oregon Health & Science University, Oregon Health & Science University, Portland.
  • Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan.
  • Department of Surgical Oncology, Centre Leon Berard, Lyon, France.
  • Department of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, Chiba, Japan.
  • Department of Clinical Medicine and Surgery, Division of Hepatobiliary Surgery, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy.
  • Clinical Research Support Office, Research Management Division, National Cancer Center, Tokyo, Japan.
  • Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
  • Kepler University Hospital GmbH, Department of General and Visceral Surgery, Medical Faculty, Johannes Kepler University, Linz, Austria.
  • Department of Gastrointestinal Surgery, Hospital, Institute of Science Tokyo, Tokyo, Japan.
  • Digestive Tumors Unit, Institut Bergonie, Universite de Bordeaux, Bordeaux, France.
  • Department of Biopathology, Institut Bergonié, Bordeaux, France.
  • Breast International Group, Brussels, Belgium.
  • Department of Oncology, Gastroenterology, Hepatology and Pulmonology, University of Leipzig Medical Center, University Cancer Center, Leipzig, Germany.
  • Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.

Abstract

IMPORTANCE

In patients with colorectal liver metastases (CLMs), the optimal treatment of disappearing liver metastases (DLMs) diagnosed on postchemotherapy computed tomography (CT) is controversial.

OBJECTIVE

To examine the diagnostic value of magnetic resonance imaging (MRI) (diffusion weighted, T1/T2, and contrast enhanced) and CT for accurate assessment of the nonviability of DLMs.

DESIGN, SETTING, AND PARTICIPANTS

This was a prospective international study including patients with initially unresectable CLMs downstaged to liver resection after chemotherapy at 21 centers in France, Austria, Belgium, the US, and Japan. A total of 233 patients were registered and 112 were enrolled between November 2016 and March 2021 with a minimum 2-year follow-up. Clinical cutoff was in September 2023, and data were analyzed from August 2024 to May 2025.

EXPOSURES

Postchemotherapy evaluation with both CT and MRI was performed. DLMs were defined as lesions that had disappeared on CT. Confirmed DLMs (cDLMs) were defined as those that had disappeared on both CT and MRI.

MAIN OUTCOMES AND MEASURES

The primary end point was the negative predictive value (NPV) of MRI and CT in assessing the nonviability of cDLMs using either pathological complete response (for resected lesions) or the absence of recurrence at the site of cDLMs during the 2-year follow-up (for lesions left behind) to confirm the true lesion status. The planned sample size was 149 evaluable cDLMs, aiming at excluding an NPV of 0.85 or lower with a 1-sided α of 5% and a power of 90%.

RESULTS

Among 112 total patients (mean [SD] age, 60.0 [10.4] years; 67 [59.8%] male) a total of 152 cDLMs and 227 DLMs were evaluable. The NPV of all evaluable cDLMs, either resected or left behind, was 62.5% (95/152; 90% CI,50.8-74.2), which was lower than the prespecified threshold. The NPV of DLMs was 52.9%. The NPVs of resected cDLMs vs those left behind were 56.8% (50/88; 90% CI, 44.2-69.5) and 70.3% (45/64; 90% CI, 48.6-92.0), respectively. For patients without extrahepatic metastases who had R0/1 resection, there was no significant difference in disease-free survival and overall survival between those with all cDLMs removed vs those with at least 1 cDLM left behind.

CONCLUSIONS AND RELEVANCE

Although the combination of MRI and CT was more accurate in detection of nonviable DLMs compared to CT alone, cDLMs did not correspond to nonviability in patients with initially unresectable CLM. Survival benefit associated with removal of cDLMs is still unclear in this setting.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02781935.

MeSH

Surgical Procedures, Operative, Drug Therapy, Liver, Neoplasm Metastasis, Wounds And Injuries, Chemotherapy