论文部分内容阅读
目的抗血管生成药物首先会导致肿瘤密度减低(Choi标准)然后是肿瘤体积的缩小[实性肿瘤疗效评价标准(RECIST)]。本项研究旨在研究目前尚不可知的转移性肾细胞癌的肿瘤密度改变对于预后的重要性。方法将采用抗血管生成药物治疗的转移性肾细胞癌的病人根据治疗反应分成部分缓解(PR)组及无反应组[包括病情稳定组(SD)及进展组(PD)],分别采用Choi及RECIST标准对两组病人进行评估,并使用log-rank检验及Cox回归模型对数据进行分析。结果 35例病人均采用了Choi及RECIST标准进行评估。对于所有8例PR病人及大部分PD病人(10/12)而言,Choi及RECIST两种标准对肿瘤治疗反应的评估具有一致性。如将肿瘤密度纳入评估信息,14例SD病人将被重新归类为:PR(7例)、SD(4例)和PD(3例)。相比SD或PD的病人,PR病人(Choi标准)的疾病无进展期有明显的延长[危险比(HR)0.24,95%CI:0.10~0.57;P=0.001]并且有更好的整体生存率(HR0.36,95%CI:0.15~0.89;P=0.026)。根据RECIST标准,PR病人的预后价值的差异没有统计学意义。结论对于转移性肾细胞癌的评估,Choi标准能够比RECIST标准更好地进行预后分组,从而能够在早期判断病人能否从持续的治疗中获益。要点①CT已经广泛应用于转移性肾细胞癌病人的病情评估。②多种算法可用于评估转移性肾细胞癌病人的肿瘤治疗控制。③随访应基于肿瘤的大小及密度的评估。④RECIST仅基于肿瘤缩小的标准,可能会导致错误的结论。
The purpose of the anti-angiogenic drug will first of all be to reduce the tumor density (Choi criteria) and then to reduce the tumor volume [RECIST]. The aim of this study was to investigate the prognostic significance of the currently unknown tumor density of metastatic renal cell carcinoma. Methods Patients with metastatic renal cell carcinoma treated with anti-angiogenic drugs were divided into partial remission (PR) group and non-responsive group (including SD and PD group) according to treatment response. Choi and RECIST criteria were used to assess both groups of patients and data were analyzed using log-rank test and Cox regression model. Results All 35 patients were evaluated using Choi and RECIST criteria. For all 8 patients with PR and most PD patients (10/12), both the Choi and RECIST criteria were consistent in assessing response to treatment with tumors. If tumor density is included in the assessment, 14 SD patients will be reclassified as PR (7 patients), SD (4 patients) and PD (3 patients). PR patients (Choi criteria) had a significantly prolonged disease-free progression compared with SD or PD patients (hazard ratio (HR) 0.24, 95% CI: 0.10-0.57; P = 0.001] and had better overall survival Rate (HR 0.36, 95% CI: 0.15-0.89; P = 0.026). According to RECIST criteria, the difference in the prognostic value of PR patients was not statistically significant. Conclusions For the assessment of metastatic renal cell carcinoma, the Choi criteria allow better prognostic grouping than the RECIST criteria, enabling early judgment of patients’ benefit from continuous treatment. Key points ① CT has been widely used in patients with metastatic renal cell carcinoma disease assessment. ② a variety of algorithms can be used to evaluate the treatment of metastatic renal cell carcinoma patients with tumor control. ③ follow-up should be based on the size and density of the tumor assessment. ④ RECIST is based on the criteria of tumor reduction only and may lead to wrong conclusions.