肿瘤体积可作为伊马替尼治疗 GIST 患者的替代应答测量指标。
Tumor volume as an alternative response measurement for imatinib treated GIST patients.
机构信息
Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands.
出版信息
PLoS One. 2012;7(11):e48372. doi: 10.1371/journal.pone.0048372. Epub 2012 Nov 2.
BACKGROUND
Assessment of tumor size changes is crucial in clinical trials and patient care. We compared imatinib-induced volume changes of liver metastases (LM) from gastro-intestinal stromal tumors (GIST) to RECIST and Choi criteria and their association with overall survival (OS).
METHODS
LM from 84 GIST patients (training and validation set) were evaluated using manual and semi-automated Computed Tomography measurements at baseline, after 3, 6 and 12 months of imatinib. The ability of uni-dimensional (1D) and three-dimensional (3D) measurements to detect size changes (increase/decrease) ≥20% was evaluated. Volumetric response cut-offs were derived from minimally relevant changes (+20/-30%) by RECIST, considering lesions as spherical or ellipsoidal.
RESULTS
3D measurements detected size changes ≥20% more frequently than 1D at every time-point (P≤0.008). 3D and Choi criteria registered more responses than RECIST at 3 and 6 months for 3D-spheres (P≤0.03) and at all time-points for 3D-ellipsoids and Choi criteria (P<0.001). Progressive disease by 3D criteria seems to better correlate to OS at late time-points than other criteria.
CONCLUSION
Volume criteria (especially ellipsoids) classify a higher number of patients as imatinib-responders than RECIST. Volume discriminates size changes better than diameter in GIST and constitutes a feasible and robust method to evaluate response and predict patient benefit.
背景
评估肿瘤大小变化在临床试验和患者护理中至关重要。我们比较了伊马替尼诱导的胃肠间质瘤（GIST）肝转移瘤（LM）的体积变化与 RECIST 和 Choi 标准及其与总生存期（OS）的关系。
方法
使用手动和半自动计算机断层扫描测量，在基线、伊马替尼治疗 3、6 和 12 个月后，对 84 例 GIST 患者（训练和验证集）的 LM 进行评估。评估了一维（1D）和三维（3D）测量在检测≥20%大小变化（增加/减少）方面的能力。根据 RECIST，考虑到病变为球形或椭圆形，通过最小相关变化（+20/-30%）得出体积反应截断值。
结果
3D 测量在每个时间点都比 1D 更频繁地检测到≥20%的大小变化（P≤0.008）。3D 和 Choi 标准在 3 个月和 6 个月时比 RECIST 标准登记了更多的反应，对于 3D 球体（P≤0.03），以及在所有时间点对于 3D 椭球体和 Choi 标准（P<0.001）。3D 标准的进展性疾病似乎比其他标准更好地与晚期的 OS 相关。
结论
与 RECIST 相比，体积标准（尤其是椭球体）将更多的患者分类为伊马替尼反应者。在 GIST 中，体积比直径更能区分大小变化，并且是一种可行且强大的方法来评估反应并预测患者受益。
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