Wesdorp Nina J, Bolhuis Karen, Roor Joran, van Waesberghe Jan-Hein T M, van Dieren Susan, van Amerongen Martin J, Chapelle Thiery, Dejong Cornelis H C, Engelbrecht Marc R W, Gerhards Michael F, Grunhagen Dirk, van Gulik Thomas M, Hermans John J, de Jong Koert P, Klaase Joost M, Liem Mike S L, van Lienden Krijn P, Molenaar I Quintus, Patijn Gijs A, Rijken Arjen M, Ruers Theo M, Verhoef Cornelis, de Wilt Johannes H W, Swijnenburg Rutger-Jan, Punt Cornelis J A, Huiskens Joost, Kazemier Geert
From the Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Ann Surg Open. 2021 Oct 28;2(4):e103. doi: 10.1097/AS9.0000000000000103. eCollection 2021 Dec.
Compare total tumor volume (TTV) response after systemic treatment to Response Evaluation Criteria in Solid Tumors (RECIST1.1) and assess the prognostic value of TTV change and RECIST1.1 for recurrence-free survival (RFS) in patients with colorectal liver-only metastases (CRLM).
RECIST1.1 provides unidimensional criteria to evaluate tumor response to systemic therapy. Those criteria are accepted worldwide but are limited by interobserver variability and ignore potentially valuable information about TTV.
Patients with initially unresectable CRLM receiving systemic treatment from the randomized, controlled CAIRO5 trial (NCT02162563) were included. TTV response was assessed using software specifically developed together with SAS analytics. Baseline and follow-up computed tomography (CT) scans were used to calculate RECIST1.1 and TTV response to systemic therapy. Different thresholds (10%, 20%, 40%) were used to define response of TTV as no standard currently exists. RFS was assessed in a subgroup of patients with secondarily resectable CRLM after induction treatment.
A total of 420 CT scans comprising 7820 CRLM in 210 patients were evaluated. In 30% to 50% (depending on chosen TTV threshold) of patients, discordance was observed between RECIST1.1 and TTV change. A TTV decrease of >40% was observed in 47 (22%) patients who had stable disease according to RECIST1.1. In 118 patients with secondarily resectable CRLM, RFS was shorter for patients with less than 10% TTV decrease compared with patients with more than 10% TTV decrease ( = 0.015), while RECIST1.1 was not prognostic ( = 0.821).
TTV response assessment shows prognostic potential in the evaluation of systemic therapy response in patients with CRLM.
比较全身治疗后总肿瘤体积（TTV）反应与实体瘤疗效评价标准（RECIST1.1），并评估TTV变化和RECIST1.1对单纯性结直肠癌肝转移（CRLM）患者无复发生存期（RFS）的预后价值。
RECIST1.1提供了评估肿瘤对全身治疗反应的一维标准。这些标准在全球范围内被接受，但受观察者间变异性的限制，并且忽略了有关TTV的潜在有价值信息。
纳入来自随机对照CAIRO5试验（NCT02162563）接受全身治疗的初始不可切除CRLM患者。使用与SAS分析软件共同专门开发的软件评估TTV反应。基线和随访计算机断层扫描（CT）用于计算RECIST1.1和对全身治疗的TTV反应。由于目前不存在标准，因此使用不同阈值（10%、20%、40%）来定义TTV反应。在诱导治疗后对具有二次可切除CRLM的患者亚组评估RFS。
共评估了210例患者的420次CT扫描，其中包含7820个CRLM。在30%至50%（取决于选择的TTV阈值）的患者中，观察到RECIST1.1与TTV变化之间存在不一致。根据RECIST1.1，47例（22%）疾病稳定的患者观察到TTV下降>40%。在118例具有二次可切除CRLM的患者中，TTV下降小于10%的患者的RFS短于TTV下降大于10%的患者（P = 0.015），而RECIST1.1无预后价值（P = 0.821）。
TTV反应评估在评估CRLM患者全身治疗反应方面显示出预后潜力。
