Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Radiol. 2010 Nov-Dec;11(6):618-26. doi: 10.3348/kjr.2010.11.6.618. Epub 2010 Oct 29.
We wanted to compare the efficacy of the new CT response evaluation criteria for predicting the tumor progression-free survival (PFS) with that of RECIST 1.1 in non-small cell lung cancer (NSCLC) patients who were treated with bevacizumab.
Sixteen patients (M:F = 11:5; median age, 57 years) treated with bevacizumab and combined cytotoxic chemotherapeutic agents were selected for a retrospective analysis. The tumor response was assessed by four different methods, namely, by using RECIST 1.1 (RECIST), RECIST but measuring only the solid component of tumor (RECISTsolid), the alternative method reflecting tumor cavitation (the alternative method) and the combined criteria (the combined criteria) that evaluated both the changes of tumor size and attenuation. To evaluate the capabilities of the different measurement methods to predict the patient prognosis, the PFS were compared, using the log rank test, among the responder groups (complete response [CR], partial response [PR], stable disease [SD] and progressive disease [PD]) in terms of the four different methods.
The overall (CR, PR or SD) response rates according to RECIST, RECISTsolid, the alternative method and the combined criteria were 81%, 88%, 81% and 85%, respectively. The confirmed response rates (CR or PR) were 19%, 19%, 50% and 54%, respectively. Although statistically not significant, the alternative method showed the biggest difference for predicting PFS among the three response groups (PR, SD and PD) (p = 0.07). RECIST and the alternative method showed a significant difference for predicting the prognosis between the good (PR or SD) and poor overall responders (p = 0.02).
The response outcome evaluations using the three different CT response criteria that reflect tumor cavitation, the ground-glass opacity component and the attenuation changes in NSCLC patients treated with bevacizumab showed different results from that with using the traditional RECIST method.
本研究旨在比较在接受贝伐珠单抗联合细胞毒化疗的非小细胞肺癌（NSCLC）患者中，新的 CT 反应评估标准预测肿瘤无进展生存期（PFS）的疗效与 RECIST1.1 的疗效。
选择 16 例接受贝伐珠单抗联合细胞毒化疗的患者进行回顾性分析。采用 4 种不同的方法评估肿瘤反应：RECIST1.1（RECIST）、仅测量肿瘤实体成分的 RECIST（RECISTsolid）、反映肿瘤空洞化的替代方法（替代方法）和评估肿瘤大小和衰减变化的联合标准（联合标准）。为了评估不同测量方法预测患者预后的能力，采用对数秩检验比较 4 种不同方法中反应者组（完全缓解[CR]、部分缓解[PR]、稳定疾病[SD]和进展性疾病[PD]）的 PFS。
根据 RECIST、RECISTsolid、替代方法和联合标准，总体（CR、PR 或 SD）缓解率分别为 81%、88%、81%和 85%。确认缓解率（CR 或 PR）分别为 19%、19%、50%和 54%。虽然统计学上无显著性差异，但替代方法在预测 PR、SD 和 PD 这三个反应组的 PFS 方面显示出最大的差异（p=0.07）。RECIST 和替代方法在预测预后方面显示出良好（PR 或 SD）和不良总体反应者（p=0.02）之间的显著差异。
在接受贝伐珠单抗治疗的 NSCLC 患者中，使用反映肿瘤空洞化、磨玻璃密度成分和衰减变化的三种不同 CT 反应标准评估反应结果与传统的 RECIST 方法有不同的结果。
