Correlation of patient survival with clinical tumor measurements in malignant pleural mesothelioma

  • Feng Li
  • Mehwish Ahmad
  • Fawwaz Qayyum
  • Christopher M. Straus
  • Heber MacMahon
  • Hedy Kindler
  • Samuel G. ArmatoIII



To evaluate differences in the tumor response classifications that result from clinical measurements and to compare these response classifications with overall survival for patients with malignant pleural mesothelioma (MPM).


One hundred thirty-one computed tomography (CT) scans were collected from 41 MPM patients enrolled in a clinical trial. Primary measurements had been acquired by clinical radiologists at a single center during routine clinical workflow, and the variability of these measurements was investigated. Retrospective measurements were acquired by a single radiologist in compliance with the study protocol based on the modified response evaluation criteria in solid tumors (RECIST). Differences in response classification categories by the two measurement approaches were evaluated and compared with patient survival.


Eleven (27%) of the 41 MPM patients had primary measurements at baseline or at follow-up that deviated from the guidelines of the clinical trial protocol. Among the 41 baseline scans, no statistical difference was observed in summed tumor measurements between primary and retrospective measurements. Response classification based on primary and retrospective measurements was different in 23 (26%) of the 90 follow-up scans, and best response was the different in seven (17%) of the 41 patients. Using Harrell’s C statistic as a measure of correlation, response based on retrospective measurements correlated better with survival (C = 0.62) than did response based on primary measurements (C = 0.57).


Strict compliance with the measurement protocol yields tumor response classifications that may differ from those obtained in clinical practice. Response based on retrospective measurements correlated better with survival than did response based on primary measurements.

Key Points

Response classifications could be different between clinical primary and retrospective measurements for malignant pleural mesothelioma.

• Response classifications obtained by strict compliance with the trial-specific protocol correlated better with survival than the classifications based on primary measurements.

• Quality assurance and radiologist training measures should be used to ensure the integrity of image-based tumor measurements in mesothelioma clinical trials.


Mesothelioma, malignant Thorax Tomography, X-ray computed Response evaluation criteria in solid tumors Survival analysis 



Computed tomography


Malignant pleural mesothelioma


Response evaluation criteria in solid tumors



This study has been presented in part at the RSNA 2011 meeting.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Feng Li.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Armato is a consultant for Aduro Biotech, Inc. Dr. MacMahon is a shareholder of Hologic and a consultant for Riverain Technologies. Drs. Li, Armato, and MacMahon receive royalties and licensing fees for computer-aided diagnosis technology through The University of Chicago. Dr. Kindler is a consultant for Merck and receives research support from Merck.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Cross sectional study

• Performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyThe University of ChicagoChicagoUSA
  2. 2.Department of MedicineThe University of ChicagoChicagoUSA

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