Trillet-Lenoir V, Freyer G, Kaemmerlen P, Fond A, Pellet O, Lombard-Bohas C, Gaudin J L, Lledo G, Mackiewicz R, Gouttebel M C, Moindrot H, Boyer J D, Chassignol L, Stremsdoerfer N, Desseigne F, Moreau J M, Hedelius F, Moraillon A, Chapuis F, Bleuse J P, Barbier Y, Heilmann M O, Valette P J
Department of Medical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite, France.
Br J Radiol. 2002 Nov;75(899):903-8. doi: 10.1259/bjr.75.899.750903.
Evaluation of tumour size modifications in response to treatment is a critical issue in the management of advanced malignancies. In 1981, the World Health Organization (WHO) established guidelines for tumour response assessment. These WHO1981 criteria were recently simplified in a revised version, named RECIST (Response Evaluation Criteria in Solid Tumours), which uses unidimensional instead of bidimensional measurements, a reduced number of measured lesions, withdrawal of the progression criteria based on isolated increase of a single lesion, and different shrinkage threshold for definitions of tumour response and progression. In order to validate these new guidelines, we have compared results obtained with both classifications in a prospective series of 91 patients receiving chemotherapy for metastatic colorectal cancer. Data from iterative tomographic measurements were fully recorded and reviewed by an expert panel. The overall response and progression rates according to the WHO1981 criteria were 19% and 58%, respectively. Using RECIST criteria, 16 patients were reclassified in a more favourable subgroup, the overall response rate being 28% and the progression rate 45% (non-weighted kappa concordance test 0.72). When isolated increase of a single measurable lesion is not taken into account for progression with the WHO1981 criteria, only 7 patients were reclassified and the kappa test was satisfying, i.e. > or =0.75, for the whole population as well as for each of the responding and progressive subgroups. Since it provides concordant results with a simplified method, the use of RECIST criteria is recommended for evaluation of treatment efficacy in clinical trials and routine practice.
评估肿瘤大小对治疗的反应变化是晚期恶性肿瘤治疗管理中的关键问题。1981年，世界卫生组织（WHO）制定了肿瘤反应评估指南。这些WHO1981标准最近在一个修订版本中得到简化，称为RECIST（实体瘤疗效评价标准），它使用一维而非二维测量，减少了测量病灶的数量，取消了基于单个病灶孤立增大的进展标准，以及肿瘤反应和进展定义的不同缩小阈值。为了验证这些新指南，我们在一组91例接受转移性结直肠癌化疗的患者前瞻性队列中比较了两种分类方法得到的结果。迭代断层扫描测量的数据由一个专家小组进行完整记录和审查。根据WHO1981标准，总体缓解率和进展率分别为19%和58%。使用RECIST标准，16例患者被重新分类到更有利的亚组，总体缓解率为28%，进展率为45%（非加权kappa一致性检验为0.72）。当WHO1981标准不将单个可测量病灶的孤立增大视为进展时，只有7例患者被重新分类，并且kappa检验对总体人群以及每个缓解和进展亚组都令人满意，即≥0.75。由于RECIST标准通过一种简化方法提供了一致的结果，因此建议在临床试验和常规实践中使用RECIST标准来评估治疗效果。
