Zheng Xinlong, Lu Tao, Wu Shiwen, Lin Xiaoyan, Bai Jing, Chen Xiaohui, Miao Qian, Yan Jianqun, Jiang Kan, Zhang Longfeng, Zheng Xiaobing, Wang Haibo, Xu Yiquan, Xiao Weijin, Li Cao, Peng Wenying, Ding Jianming, Zhong Qiaofeng, Zou Zihua, Yang Shanshan, Li Yujing, Chen Sihui, Zhang Qiuyu, Yan Jianfeng, Tang Guofeng, Cai Yuandong, Kang Miao, Mok Tony S K, Lin Gen
Department of Thoracic Oncology Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital Fuzhou China.
Department of Radiology Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital Fuzhou China.
MedComm (2020). 2024 Mar 9;5(3):e493. doi: 10.1002/mco2.493. eCollection 2024 Mar.
Treatment response and prognosis estimation in advanced pulmonary adenocarcinoma are challenged by the significant heterogeneity of the disease. The current Response Evaluation Criteria in Solid Tumors (RECIST) criteria, despite providing a basis for solid tumor response evaluation, do not fully encompass this heterogeneity. To better represent these nuances, we introduce the intertumoral heterogeneity response score (THRscore), a measure built upon and expanding the RECIST criteria. This retrospective study included patients with 3-10 measurable advanced lung adenocarcinoma lesions who underwent first-line chemotherapy or targeted therapy. The THRscore, derived from the coefficient of variation in size for each measurable tumor before and 4-6 weeks posttreatment, unveiled a correlation with patient outcomes. Specifically, a high THRscore was associated with shorter progression-free survival, lower tumor response rate, and a higher tumor mutation burden. These associations were further validated in an external cohort, confirming THRscore's effectiveness in stratifying patients based on progression risk and treatment response, and enhancing the utility of RECIST in capturing complex tumor behaviors in lung adenocarcinoma. These findings affirm the promise of THRscore as an enhanced tool for tumor response assessment in advanced lung adenocarcinoma, extending the RECIST criteria's utility.
晚期肺腺癌的治疗反应和预后评估因该疾病显著的异质性而面临挑战。当前的实体瘤疗效评价标准（RECIST）尽管为实体瘤反应评估提供了基础，但并未完全涵盖这种异质性。为了更好地体现这些细微差别，我们引入了瘤间异质性反应评分（THRscore），这是一种基于RECIST标准并对其进行扩展的测量方法。这项回顾性研究纳入了3至10个可测量的晚期肺腺癌病灶且接受一线化疗或靶向治疗的患者。THRscore源自每个可测量肿瘤在治疗前及治疗后4至6周大小的变异系数，揭示了其与患者预后的相关性。具体而言，高THRscore与无进展生存期缩短、肿瘤反应率降低以及肿瘤突变负荷增加相关。这些关联在一个外部队列中得到进一步验证，证实了THRscore在根据进展风险和治疗反应对患者进行分层方面的有效性，并增强了RECIST在捕捉肺腺癌复杂肿瘤行为方面的效用。这些发现肯定了THRscore作为晚期肺腺癌肿瘤反应评估增强工具的前景，扩展了RECIST标准的效用。
