Hiram C Polk Jr MD Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY 40202, USA.
J Am Coll Surg. 2013 Apr;216(4):845-56; discussion 856-7. doi: 10.1016/j.jamcollsurg.2012.12.037. Epub 2013 Feb 13.
The Response Evaluation Criteria in Solid Tumors (RECIST), which evaluates maximum tumor diameter only, is commonly used to determine response to chemotherapy in patients with colorectal liver metastases. Limitations of RECIST include its inability to assess the changes in tumor enhancement. The aim of this study was to assess the correlation of these criteria as well as the modified RECIST (mRECIST) with pathologic tumor response. A novel semi-automated volumetric assessment of tumor size was also investigated.
A review of a 1,948-patient prospective hepatic database to assess response and pathologic criteria was performed. Patients undergoing preoperative chemotherapy before hepatic resection for colorectal liver metastases were reviewed. Radiographic responses according to RECIST and mRECIST were determined. The percentage of viable tumor cells compared with the total tumor area was determined from the pathologic specimens.
We identified 38 patients with adequate imaging who had undergone anatomic hepatic resection and full pathologic evaluation. The percentages of residual viable tumor in the resected specimens were significantly different across RECIST categories (p = 0.045), but not mRECIST (p = 0.305). For mRECIST, there were improved and significant linear trends for residual viable tumor, necrosis, and necrosis + fibrosis when compared with RECIST (p = 0.056). Neither RECIST nor mRECIST responses were predictive of residual viable tumor burden in regression analyses. A novel semi-automated volumetric assessment of tumor size correlated well with pathologic tumor size.
Neither RECIST nor mRECIST were predictive of residual viable burden, although the linear trend for mRECIST and residual necrosis + fibrosis compared favorably with RECIST. Continued evaluation for tumor enhancement and standardization of tumor size remain a critical unmet need in patients with solid organ disease.
RECIST（实体瘤反应评估标准）仅评估最大肿瘤直径，常用于评估结直肠癌肝转移患者化疗的反应。RECIST 的局限性包括其无法评估肿瘤增强的变化。本研究旨在评估这些标准以及改良 RECIST（mRECIST）与病理肿瘤反应的相关性。还研究了一种新的肿瘤大小半自动体积评估方法。
回顾了一个 1948 例患者的前瞻性肝脏数据库，以评估反应和病理标准。回顾了接受结直肠癌肝转移肝切除术前化疗的患者。根据 RECIST 和 mRECIST 确定放射学反应。从病理标本中确定与总肿瘤面积相比的存活肿瘤细胞百分比。
我们确定了 38 例有足够影像学表现并接受解剖性肝切除和完整病理评估的患者。在 RECIST 类别中，切除标本中残留存活肿瘤的百分比存在显著差异（p = 0.045），但在 mRECIST 中则无差异（p = 0.305）。与 RECIST 相比，mRECIST 具有更好的线性趋势，用于预测残留存活肿瘤、坏死和坏死+纤维化（p = 0.056）。在回归分析中，无论是 RECIST 还是 mRECIST 反应都不能预测残留存活肿瘤负担。肿瘤大小的新半自动体积评估与病理肿瘤大小相关性良好。
尽管 mRECIST 与残留坏死+纤维化的线性趋势优于 RECIST，但 RECIST 和 mRECIST 均不能预测残留存活肿瘤负担。在实体器官疾病患者中，肿瘤增强的持续评估和肿瘤大小的标准化仍然是一个未满足的关键需求。
