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Comparing response assessment categories of WHO, RECIST, mRECIST for hepatocellular carcinoma, and EASL classifications

Comparing response assessment categories of WHO, RECIST, mRECIST for hepatocellular carcinoma, and EASL classifications
Parameters Baseline measurements Complete response (CR) Partial response (PR) Stable disease (SD) Progressive disease (PD)
Conventional criteria
WHO

Measurable, bidimensional (product of LD and greatest perpendicular diameter)

Non-measurable/evaluable (eg, lymphangitic pulmonary metastases, abdominal masses)
Measurable and non-measurable disease: Disappearance of all lesions, confirmed at ≥4 weeks

Measurable disease: ≥50% decrease in the sum of the area (longest diameters multiplied by longest perpendicular diameters), confirmed at ≥4 weeks

Non-measurable: Estimated ≥50% decrease confirmed at ≥4 weeks
Neither PR nor PD (no change)

Measurable disease: ≥25% increase in the sum of the area of existent lesions, or new lesions

Non-measurable disease: Estimated increase ≥25%, or new lesions
RECIST 1.0

Measurable, unidimensional (LD only, size with conventional techniques ≥20 mm, with spiral CT ≥10 mm)

Target lesions: Up to 10; no more than 5 per organ

Non-measurable: All other lesions, including small lesions; evaluable is not recommended
Target lesions: Disappearance of all lesions, confirmed at ≥4 weeks Target lesions: ≥30% decrease in the sum of the longest diameters, confirmed at ≥4 weeks Neither PR nor PD Target lesions: ≥20% increase in the sum of the longest diameters over the smallest sum observed, or new lesions
RECIST 1.1

Measurable, unidimensional (LD only, size with conventional techniques ≥20 mm, with spiral CT ≥10 mm). For nodes, target = short axis ±15 mm; non-target 10 to 15 mm nodes; normal <10 mm.

Non-measurable: All other lesions, including small lesions; evaluable is not recommended
Disappearance of all lesions and pathological lymph nodes ≥30% decrease in the sum of the longest diameters Neither PR nor PD ≥20% increase in the sum of the longest diameters and ≥5 mm absolute increase in the sum of the longest diameters, or new lesions
Newer criteria[1]
EASL Same as WHO Disappearance of all intratumoral arterial enhancement ≥50% decrease in the total tumor load of all measurable lesions (sum of the arterially enhancing areas, longest diameters multiplied by longest perpendicular diameters) determined by two observations, at least four weeks apart Neither PR nor PD ≥25% increase in the size of one or more arterially enhancing areas or development of a new lesion(s)
mRECIST Same as RECIST 1.1 Disappearance of any intratumoral arterial enhancement in all target lesions At least a 30% decrease in the sum of diameters of viable (enhancing) target lesions, taking as reference the baseline sum of the target lesions Neither PR nor PD ≥20% increase in the sum of the diameters of viable target lesions recorded since treatment initiation, or development of a new lesion(s)
WHO: World Health Organization; RECIST: Response Evaluation Criteria In Solid Tumor; EASL: European Association for the Study of the Liver; mRECIST: modified RECIST; LD: longest diameter; NC: no change.
Reference:
  1. Yaghmai V, Besa C, Kim E, et al. Imaging assessment of hepatocellular carcinoma response to locoregional and systemic therapy. AJR Am J Roentgenol 2013; 201:80.
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