Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
AJR Am J Roentgenol. 2010 Jun;194(6):1470-8. doi: 10.2214/AJR.09.3456.
The objective of our study was to evaluate response assessment and predict clinical outcome in patients with metastatic renal cell carcinoma (RCC) receiving antiangiogenic targeted therapy. Target lesions were assessed on routine contrast-enhanced CT (CECT) images obtained during the portal venous phase using new response criteria.
Standard CECT examinations of patients with metastatic clear cell RCC on first-line sunitinib or sorafenib therapy (n = 84) were retrospectively evaluated using Mass, Attenuation, Size, and Structure (MASS) Criteria; Response Evaluation Criteria in Solid Tumors (RECIST); Size and Attenuation CT (SACT) Criteria; and modified Choi Criteria. The objective response to therapy was compared with clinical outcomes including time to progression (TTP) and disease-specific survival. The Kaplan-Meier method was used to estimate survival functions.
A favorable response according to MASS Criteria had a sensitivity of 86% and specificity of 100% in identifying patients with a good clinical outcome (i.e., progression-free survival of > 250 days) versus 17% and 100%, respectively, for RECIST partial response. The objective categories of response used by MASS Criteria-favorable response, indeterminate response, and unfavorable response-differed significantly from one another with respect to TTP (p < 0.0001, log-rank test) and disease-specific survival (p < 0.0001, log-rank test).
Assessment of metastatic RCC target lesions on CECT for changes in morphology, attenuation, size, and structure by MASS Criteria is more accurate than response assessment by SACT Criteria, RECIST, or modified Choi Criteria. Furthermore, the use of MASS Criteria for imaging response assessment showed high interobserver agreement and may predict disease outcome in patients with metastatic RCC on targeted therapy.
本研究旨在评估接受抗血管生成靶向治疗的转移性肾细胞癌（RCC）患者的反应评估和预测临床结局。使用新的反应标准，在门静脉期获得的常规对比增强 CT（CECT）图像上评估靶病灶。
回顾性评估接受一线舒尼替尼或索拉非尼治疗的转移性透明细胞 RCC 患者（n = 84）的标准 CECT 检查，使用质量、衰减、大小和结构（MASS）标准、实体瘤反应评估标准（RECIST）、大小和衰减 CT（SACT）标准和改良 Choi 标准。将治疗的客观反应与包括无进展生存期（TTP）和疾病特异性生存期在内的临床结局进行比较。使用 Kaplan-Meier 方法估计生存函数。
MASS 标准的有利反应在识别具有良好临床结局（即无进展生存期 > 250 天）的患者方面具有 86%的敏感性和 100%的特异性，而 RECIST 部分反应的敏感性和特异性分别为 17%和 100%。MASS 标准使用的反应目标类别-有利反应、不确定反应和不利反应-在 TTP（p < 0.0001，对数秩检验）和疾病特异性生存（p < 0.0001，对数秩检验）方面差异显著。
使用 MASS 标准评估 CECT 上转移性 RCC 靶病灶的形态、衰减、大小和结构变化的反应评估比 SACT 标准、RECIST 或改良 Choi 标准更准确。此外，使用 MASS 标准进行成像反应评估具有较高的观察者间一致性，并可能预测接受靶向治疗的转移性 RCC 患者的疾病结局。
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