Liu Kun, Li Guoli, Fan Chaogang, Zhou Changsheng, Li Jieshou
Department of Surgery, Jinling Hospital, Medical School of Nanjing University, China.
Acta Radiol. 2012 Mar 1;53(2):127-34. doi: 10.1258/ar.2011.110273. Epub 2011 Dec 12.
Tumor response to chemotherapy has traditionally been assessed by using Response Evaluation Criteria in Solid Tumors (RECIST) based on changes in tumor size alone. However, adapted Choi criteria, which incorporate volumetric tumor attenuation in addition to tumor size, have been reported more predictive of chemotherapeutic efficacy than RECIST in some studies.
To examine the usefulness of adapted Choi criteria in predicting clinical survival in locally advanced gastric cancer patients treated with cytotoxic drugs.
A total of 48 histologically proven gastric cancer patients who received neoadjuvant chemotherapy and surgery were involved. Pre- and post-chemotherapy short-axis diameter and volumetric mean tumor attenuation of target lymph nodes on contrast-enhanced CT images were measured. Tumor response was assessed by using both RECIST and adapted Choi criteria, and was correlated with progression-free survival (PFS) and overall survival (OS).
Significant decrease was observed in the sum of short-axis diameters and tumor attenuation of metastatic lymph nodes between baseline and post-chemotherapy CT images. The inter-observer agreement for both parameters was good. The PFS and OS of 17 RECIST responders were identical with that of 28 adapted Choi responders (P = 0.855 and 0.913, respectively). PFS and OS of 31 RECIST non-responders were significantly prolonged compared to that of 20 adapted Choi non-responders (P = 0.018 and 0.042, respectively). To the 11 RECIST stable disease (SD) but adapted Choi partial response (PR) patients, the PFS and OS were similar to the survival of 17 RECIST PR patients (P = 0.785 and 0.838, respectively), but significantly prolonged compared to that of the 12 both RECIST and adapted Choi criteria SD patients (P < 0.001 and P = 0.004, respectively).
Adapted Choi criteria might be helpful to predict PFS and OS in locally advanced gastric cancer patients following chemotherapy.
传统上，实体瘤的化疗反应是通过仅基于肿瘤大小变化的实体瘤疗效评价标准（RECIST）来评估的。然而，在一些研究中，已报道除肿瘤大小外还纳入肿瘤体积衰减的改良Choi标准比RECIST更能预测化疗疗效。
探讨改良Choi标准在预测接受细胞毒性药物治疗的局部晚期胃癌患者临床生存方面的实用性。
共纳入48例经组织学证实接受新辅助化疗和手术的胃癌患者。在对比增强CT图像上测量化疗前后靶淋巴结的短轴直径和肿瘤体积平均衰减值。使用RECIST和改良Choi标准评估肿瘤反应，并将其与无进展生存期（PFS）和总生存期（OS）相关联。
化疗前后CT图像上转移淋巴结的短轴直径总和及肿瘤衰减值均显著降低。两位观察者对这两个参数的一致性良好。17例RECIST标准的反应者的PFS和OS与28例改良Choi标准的反应者相同（P分别为0.855和0.913）。31例RECIST标准的无反应者的PFS和OS显著长于20例改良Choi标准的无反应者（P分别为0.018和0.042）。对于11例RECIST标准为疾病稳定（SD）但改良Choi标准为部分缓解（PR）的患者，其PFS和OS与17例RECIST标准为PR的患者相似（P分别为0.785和0.838），但显著长于12例RECIST标准和改良Choi标准均为SD的患者（P分别<0.001和0.004）。
改良Choi标准可能有助于预测局部晚期胃癌患者化疗后的PFS和OS。
