CT radiomics show disparities in colorectal cancer treatment efficacy

2021 10 04 18 46 2240 Colorectal Cancer 400

CT radiomics data show significant associations between race and ethnicity and treatment efficacy for metastatic colorectal cancer, according to research presented at the RSNA meeting.

The findings suggest that there's more work to be done to determine how a diverse patient population responds to metastatic colorectal cancer treatment -- especially since racial and ethnic minorities face a "disproportionate burden for adverse cancer outcomes" compared with their white counterparts, presenter Melissa Yang of the University of Texas Health Science Center in Houston, TX, told session attendees.

"Despite encouraging trends in decreasing cancer incidence and mortality across population groups, racial and ethnic minorities face a disproportionate burden for adverse cancer outcomes compared to [white individuals]," she said.

Radiomics developed for medical imaging show promise for improving clinical assessment of patients presenting with disease. But they tend to be based on a single ethnic group -- often white people -- and may be biased when applied to diverse patient cohorts.

"Multivariate analytical methods developed in populations of a single ethnic group may introduce biases in clinical assessment that can unintentionally bias care when applied to populations not involved in the original analyses," Yang's group noted.

The team conducted a study that included CT images from 1,584 metastatic colorectal cancer patients who participated in two phase 3 trials conducted in both Europe and the U.S. The trials evaluated two chemotherapy protocols: panitumumab plus FOLFOX (681 patients) and FOLFIRI /aflibercept (903 patients). Yang's group used a set of 720 CT images to train and validate a radiomics algorithm to predict overall survival from month two of treatment completion, comparing baseline tumor volume to any changes volume or spatial heterogeneity and taking patients' self-reported ethnicity into account.

Patient-identified ethnicity included the following:

  • European: 89.2%
  • Asian: 4.2%
  • African: 3.2%
  • Latinx: 1.7%
  • Other: 1.8%

The study showed that median overall survival among the whole cohort was 13.9 months. Caucasians and Latinx study participants had longer overall survival rates, although this result was not statistically significant, Yang said. But overall baseline tumor volume varied among ethnic groups, as did overall change in tumor volume.

Differences in metastatic colorectal cancer volume by racial group
Measure Caucasian Asian African Latinx
Overall baseline tumor volume 82.75 cm3 46.61 cm3 93.55 cm3 57.84 cm3
Overall change in tumor volume at month 2 post-treatment -34.64 cm3 -8.45 cm3 -31.59 cm3 -80.03 cm3

The study findings underscore the need for more research, according to Yang and colleagues.

"Further study is warranted in future trials that better represent minority groups to impact treatment paradigms," they wrote.

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