Trial reportEuropean radiology2018
CT attenuation of liver metastases before targeted therapy is a prognostic factor of overall survival in colorectal cancer patients. Results from the randomised, open-label FIRE-3/AIO KRK0306 trial.
Trial report in European radiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 25 citations in OpenAlex.
- Prognostic value of the tumor-to-liver density ratio in patients with metastatic colorectal cancer treated with bevacizumab-based chemotherapy. A post-hoc study of the STIC-AVASTIN trial.Cancer imaging : the official publication of the International Cancer Imaging Society · 2024Trial
- Interobserver Variability in CT-based Morphologic Tumor Response Assessment of Colorectal Liver Metastases.Radiology. Imaging cancer · 2022Trial
- Spectral CT imaging in colorectal cancer: current applications, limitations, and future perspectives.Insights into imaging · 2026Review
- Computed tomography-based deep learning radiomics model for preoperative prediction of tumor immune microenvironment in colorectal cancer.World journal of gastrointestinal oncology · 2025Article
- Textural heterogeneity of liver lesions in CT imaging - comparison of colorectal and pancreatic metastases.Abdominal radiology (New York) · 2024Article
- Predictive Value of Quantitative Parameters ofDiagnostics (Basel, Switzerland) · 2024Article
- Photon-counting computed tomography versus energy-integrating computed tomography for detection of small liver lesions: comparison using a virtual framework imaging.Journal of medical imaging (Bellingham, Wash.) · 2024Article
- Article
- Tumor classification of gastrointestinal liver metastases using CT-based radiomics and deep learning.Cancer imaging : the official publication of the International Cancer Imaging Society · 2023Article
- The Potential and Emerging Role of Quantitative Imaging Biomarkers for Cancer Characterization.Cancers · 2022Review
- Does the Computed Tomography Hounsfield Units Change Predict Response to Perioperative Chemotherapy in Patients with Gastric Adenocarcinoma.Journal of Cancer · 2022Article
- The relevance of CT-based geometric and radiomics analysis of whole liver tumor burden to predict survival of patients with metastatic colorectal cancer.European radiology · 2021Article
- Current state of the art imaging approaches for colorectal liver metastasis.Hepatobiliary surgery and nutrition · 2020Review
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Authors and funding
15 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the prognostic value of pre-therapeutic computed tomography (CT) attenuation of liver metastases for overall survival (OS) in metastatic colorectal cancer (mCRC).
methodsIn the open-label, randomised, prospective phase-III FIRE-3 trial, patients with histologically confirmed mCRC received fluorouracil (5-FU), leucovorin and irinotecan (FOLFIRI) with either cetuximab or bevacizumab. Participating patients gave written informed consent prior to study entry. In CT at baseline (portal venous phase, slice thickness ≤5 mm), mean attenuation [Hounsfield units (HU)] of liver metastases was retrospectively assessed by semi-automated volumetry. Its prognostic influence on OS was analysed in Kaplan-Meier-analysis and Cox proportional hazard regression and an optimal threshold was determined.
resultsIn FIRE-3, 592 patients were enrolled between 2007 and 2012. Among the 347 patients eligible for liver volumetry, median baseline CT attenuation of liver metastases was 59.67 HU [interquartile range (IQR), 49.13, 68.85]. Increased attenuation was associated with longer OS {per 10 HU: hazard ratio (HR), 0.85 [95% confidence interval (CI), 0.78, 0.93], p < 0.001}. The optimised threshold (≥61.62 HU) was a strong predictor for increased OS [median, 21.3 vs 30.6 months; HR, 0.61 (95% CI, 0.47, 0.80), p < 0.001]. Multivariate regression controlling for correlated and further prognostic factors confirmed this [HR, 0.60 (95% CI, 0.45, 0.81), p = 0.001]. Furthermore, mean attenuation ≥61.62 HU was significantly associated with increased early tumour shrinkage (p = 0.002) and increased depth of response (p = 0.012).
conclusionsIncreased mean baseline CT attenuation of liver metastases may identify mCRC patients with prolonged OS and better tumour response. KEY POINTS: • In colorectal cancer, increased attenuation of liver metastases in baseline computed tomography is a prognostic factor for prolonged OS (p < 0.001). • A threshold of ≥61.62 HU was determined as optimal cut-off to identify patients with prolonged OS (p < 0.001), early tumour shrinkage (p = 0.002) and increased depth of response (p = 0.012).
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