Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital of Palermo, Palermo, Italy.
AJR Am J Roentgenol. 2019 Dec;213(6):1232-1239. doi: 10.2214/AJR.18.20842. Epub 2019 Oct 15.
The purpose of this study was to investigate whether, compared with traditional criteria, the modified Response Evaluation Criteria in Solid Tumors version 1.1 for immune-based therapeutics (iRECIST) improves prediction of local tumor control and survival in patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT). Fifty-one HCC lesions (mean size, 3.1 cm) treated with SBRT in 41 patients (mean age, 67 years) were retrospectively included. Each patient underwent CT or MRI before SBRT and at least once after SBRT. Best overall response was categorized using Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), iRECIST, World Health Organization (WHO) criteria, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and European Association for the Study of the Liver (EASL) criteria. Lesions were then classified as local tumor control (i.e., stable disease, partial response, or complete response) or local treatment failure (i.e., progressive disease) by each tumor response criteria. Proportions of local tumor control were compared using the McNemar exact test. The 1-year overall survival was estimated using the Kaplan-Meier method. The median follow-up after SBRT was 21.0 months. The local tumor control rate was 94.1% (48/51) by iRECIST, 88.2% (45/51) by RECIST 1.1, 72.5% (37/51) by WHO criteria, 80.4% (41/51) by mRECIST, and 72.5% (37/51) by EASL criteria. The local tumor control rate was significantly higher according to iRECIST compared with WHO ( = 0.0010) and EASL ( = 0.0225) criteria. The 1-year survival rate for patients with local tumor control according to iRECIST (86.4%) was higher (although not statistically significant) compared with the 1-year survival rate for patients with local tumor control according to the other response criteria. iRECIST may provide more robust interpretation of HCC response after SBRT, yielding improved prediction of local tumor control and 1-year survival rates compared with traditional criteria.
本研究旨在探讨与传统标准相比，免疫治疗的改良实体瘤反应评估标准 1.1 版（iRECIST）是否能提高对接受立体定向体部放疗（SBRT）治疗的肝细胞癌（HCC）患者局部肿瘤控制和生存的预测。 本研究回顾性纳入了 41 例患者的 51 个 HCC 病变（平均大小 3.1cm），这些患者接受 SBRT 治疗。每位患者在 SBRT 前和 SBRT 后至少进行一次 CT 或 MRI 检查。使用实体瘤反应评估标准 1.1 版（RECIST 1.1）、iRECIST、世界卫生组织（WHO）标准、改良实体瘤反应评估标准（mRECIST）和欧洲肝脏研究协会（EASL）标准对最佳总反应进行分类。然后，根据每个肿瘤反应标准，将病变分为局部肿瘤控制（即稳定疾病、部分缓解或完全缓解）或局部治疗失败（即进展性疾病）。使用 McNemar 精确检验比较局部肿瘤控制的比例。使用 Kaplan-Meier 方法估计 1 年总生存率。 SBRT 后中位随访时间为 21.0 个月。根据 iRECIST，局部肿瘤控制率为 94.1%（48/51），根据 RECIST 1.1 为 88.2%（45/51），根据 WHO 标准为 72.5%（37/51），根据 mRECIST 为 80.4%（41/51），根据 EASL 标准为 72.5%（37/51）。与 WHO（ = 0.0010）和 EASL（ = 0.0225）标准相比，根据 iRECIST 的局部肿瘤控制率显著更高。根据 iRECIST，局部肿瘤控制患者的 1 年生存率（86.4%）高于（尽管无统计学意义）根据其他反应标准的局部肿瘤控制患者的 1 年生存率。 iRECIST 可能为 SBRT 后 HCC 反应提供更可靠的解释，与传统标准相比，能更准确地预测局部肿瘤控制和 1 年生存率。
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