Benjamin Robert S, Choi Haesun, Macapinlac Homer A, Burgess Michael A, Patel Shreyaskumar R, Chen Lei L, Podoloff Donald A, Charnsangavej Chuslip
Department of Sarcoma Medical Oncology and the Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
J Clin Oncol. 2007 May 1;25(13):1760-4. doi: 10.1200/JCO.2006.07.3411.
Response Evaluation Criteria in Solid Tumors (RECIST) are insensitive in evaluating imatinib-treated gastrointestinal stromal tumors (GISTs). Response by Choi criteria, a 10% decrease in size or a 15% decrease in density on contrast-enhanced CT, correlated well in a small training set of patients who showed response as measured by positron emission tomography, and was more predictive of time to tumor progression (TTP) than response by RECIST. This study was designed to validate these observations in an independent data set.
Fifty-eight patients with imatinib-treated GISTs were evaluated by RECIST and Choi criteria. TTP was compared with TTP in the training set. Patients were analyzed initially with follow-up to 28 months, extended to 60 months for survival analysis.
Patients who met Choi response criteria on CT at 2 months had significantly better TTP than those who did not (P = .0002), whereas response group by RECIST was not significantly correlated with TTP. Even when the 98 patients from both sets were analyzed together, the response group by RECIST did not correlate significantly with TTP, whereas response group by Choi criteria did correlate significantly with TTP. Disease-specific survival (DSS) was also significantly correlated with response group by Choi criteria (P = .04), but not with response group by RECIST.
Choi response criteria are reproducible, more sensitive, and more precise than RECIST in assessing the response of GISTs to imatinib mesylate. Response by Choi criteria, unlike response by RECIST, correlates significantly with TTP and DSS. Response by Choi criteria should be incorporated routinely into future studies of GIST therapy. We should desist using RECIST, at least in GIST.
实体瘤疗效评价标准（RECIST）在评估伊马替尼治疗的胃肠道间质瘤（GIST）时不够敏感。Choi标准以对比增强CT上肿瘤大小缩小10%或密度降低15%作为反应标准，在一组小样本的经正电子发射断层扫描测定显示有反应的患者训练集中，该标准与反应情况相关性良好，并且比RECIST标准更能预测肿瘤进展时间（TTP）。本研究旨在在一个独立数据集中验证这些观察结果。
采用RECIST标准和Choi标准对58例接受伊马替尼治疗的GIST患者进行评估。将这些患者的TTP与训练集中患者的TTP进行比较。最初对患者进行至28个月的随访分析，之后将随访时间延长至60个月进行生存分析。
在2个月时CT符合Choi反应标准的患者，其TTP显著优于不符合该标准的患者（P = 0.0002），而RECIST标准下的反应组与TTP无显著相关性。即使将两组的98例患者一起分析，RECIST标准下的反应组与TTP仍无显著相关性，而Choi标准下的反应组与TTP显著相关。疾病特异性生存（DSS）也与Choi标准下的反应组显著相关（P = 0.04），但与RECIST标准下的反应组无关。
在评估GIST对甲磺酸伊马替尼的反应时，Choi反应标准比RECIST标准更具可重复性、更敏感且更精确。与RECIST标准不同，Choi标准下的反应与TTP和DSS显著相关。Choi标准下的反应应常规纳入未来GIST治疗研究中。我们应停止使用RECIST标准，至少在GIST研究中应如此。
