Published Online:https://doi.org/10.1148/radiol.13130776

The combination of baseline serum lactate dehydrogenase level and assessment of tumor devascularization at the first CT examination after bevacizumab therapy by using the Morphology, Attenuation, Size, and Structure, or MASS, criteria was highly accurate for prediction of survival in patients with metastatic melanoma.

Purpose

To predict survival in patients with metastatic melanoma by evaluating a combination of serum lactate dehydrogenase (LDH) level and initial computed tomographic (CT) findings of tumor devascularization after antiangiogenic therapy.

Materials and Methods

Consent was waived for this institutional review board–approved, retrospective, secondary analysis. Forty-four patients with metastatic melanoma received bevacizumab therapy in a randomized prospective phase II trial. Target lesions on the initial posttherapy CT images were evaluated by using Response Evaluation Criteria in Solid Tumors, the Choi criteria, and Morphology, Attenuation, Size, and Structure (MASS) criteria. Cox proportional hazards models were used to assess the association of baseline clinical variables including serum LDH and imaging findings with progression-free and overall survival. The receiver operating characteristic curve with area under the curve (AUC) was used to evaluate accuracy.

Results

In multivariate analysis, a high baseline serum LDH level was associated with decreased progression-free survival (hazard ratio = 1.29 for each increase of 100 IU/L; P = .002) and overall survival (hazard ratio = 1.44 for each increase of 100 IU/L; P = .001). Evaluation with MASS criteria of the first CT examination after therapy strongly predicted progression-free (P < .001) and overall (P < .001) survival. Baseline serum LDH level was moderately accurate for predicting progression-free survival at 9 months (AUC = 0.793) and overall survival at 18 months (AUC = 0.689). The combination of baseline serum LDH levels and evaluation with MASS criteria at the first CT examination after therapy had significantly higher accuracy for predicting progression-free survival at 9 months (AUC = 0.969) and overall survival at 18 months (AUC = 0.813) than did baseline serum LDH levels alone for prediction of progression-free survival (P = .020).

Conclusion

A combination of baseline serum LDH levels and evaluation with MASS criteria at the first CT examination after bevacizumab therapy had the highest accuracy for predicting survival in patients with metastatic melanoma.

© RSNA, 2013

Online supplemental material is available for this article.

References

  • 1. Heakal Y, Kester M, Savage S. Vemurafenib (PLX4032): an orally available inhibitor of mutated BRAF for the treatment of metastatic melanoma. Ann Pharmacother 2011;45(11):1399–1405. Crossref, MedlineGoogle Scholar
  • 2. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009;27(36):6199–6206. Crossref, MedlineGoogle Scholar
  • 3. Gogas H, Eggermont AM, Hauschild A, et al. Biomarkers in melanoma. Ann Oncol 2009;20(Suppl 6):vi8–vi13. CrossrefGoogle Scholar
  • 4. González-Cao M, Viteri S, Díaz-Lagares A, et al. Preliminary results of the combination of bevacizumab and weekly Paclitaxel in advanced melanoma. Oncology 2008;74(1-2):12–16. Crossref, MedlineGoogle Scholar
  • 5. Grignol VP, Olencki T, Relekar K, et al. A phase 2 trial of bevacizumab and high-dose interferon alpha 2B in metastatic melanoma. J Immunother 2011;34(6):509–515. Crossref, MedlineGoogle Scholar
  • 6. Perez DG, Suman VJ, Fitch TR, et al. Phase 2 trial of carboplatin, weekly paclitaxel, and biweekly bevacizumab in patients with unresectable stage IV melanoma: a North Central Cancer Treatment Group study, N047A. Cancer 2009;115(1):119–127. Crossref, MedlineGoogle Scholar
  • 7. Varker KA, Biber JE, Kefauver C, et al. A randomized phase 2 trial of bevacizumab with or without daily low-dose interferon alfa-2b in metastatic malignant melanoma. Ann Surg Oncol 2007;14(8):2367–2376. Crossref, MedlineGoogle Scholar
  • 8. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45(2):228–247. Crossref, MedlineGoogle Scholar
  • 9. Smith AD, Shah SN, Rini BI, Lieber ML, Remer EM. Utilizing pre-therapy clinical schema and initial CT changes to predict progression-free survival in patients with metastatic renal cell carcinoma on VEGF-targeted therapy: A preliminary analysis. Urol Oncol 2011 Sep 26. [Epub ahead of print] Google Scholar
  • 10. Benjamin RS, Choi H, Macapinlac HA, et al. We should desist using RECIST, at least in GIST. J Clin Oncol 2007;25(13):1760–1764. Crossref, MedlineGoogle Scholar
  • 11. Choi H, Charnsangavej C, Faria SC, et al. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 2007;25(13):1753–1759. Crossref, MedlineGoogle Scholar
  • 12. Choi H. Response evaluation of gastrointestinal stromal tumors. Oncologist 2008;13(Suppl 2):4–7. Crossref, MedlineGoogle Scholar
  • 13. Smith AD, Lieber ML, Shah SN. Assessing tumor response and detecting recurrence in metastatic renal cell carcinoma on targeted therapy: importance of size and attenuation on contrast-enhanced CT. AJR Am J Roentgenol 2010;194(1):157–165. Crossref, MedlineGoogle Scholar
  • 14. Smith AD, Shah SN, Rini BI, Lieber ML, Remer EM. Morphology, Attenuation, Size, and Structure (MASS) criteria: assessing response and predicting clinical outcome in metastatic renal cell carcinoma on antiangiogenic targeted therapy. AJR Am J Roentgenol 2010;194(6):1470–1478. Crossref, MedlineGoogle Scholar
  • 15. Nishino M, Jagannathan JP, Ramaiya NH, Van den Abbeele AD. Revised RECIST guideline version 1.1: What oncologists want to know and what radiologists need to know. AJR Am J Roentgenol 2010;195(2):281–289. Crossref, MedlineGoogle Scholar
  • 16. Heagerty PJ, Zheng Y. Survival model predictive accuracy and ROC curves. Biometrics 2005;61(1):92–105. Crossref, MedlineGoogle Scholar
  • 17. Efron B, Tibshirani RJ. An introduction to the bootstrap. In: Efron B, ed. Monographs on statistics and applied probability. Boca Raton, Fla: Chapman & Hall/CRC, 1994; 168–177. CrossrefGoogle Scholar
  • 18. Faivre S, Zappa M, Vilgrain V, et al. Changes in tumor density in patients with advanced hepatocellular carcinoma treated with sunitinib. Clin Cancer Res 2011;17(13):4504–4512. Crossref, MedlineGoogle Scholar
  • 19. Chung WS, Park MS, Shin SJ, et al. Response evaluation in patients with colorectal liver metastases: RECIST version 1.1 versus modified CT criteria. AJR Am J Roentgenol 2012;199(4):809–815. Crossref, MedlineGoogle Scholar

Article History

Received April 8, 2013; revision requested May 13; revision received June 5; accepted June 19; final version accepted July 19.
Published online: Feb 2014
Published in print: Feb 2014