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目的比较实体瘤疗效评价标准(RECIST)及Choi标准对伊马替尼治疗胃肠间质瘤(gastroIntestinal stromal tumor,GIST)CT早期疗效评价的应用价值。方法回顾性分析2003年4月至2008年1月北京大学临床肿瘤学院应用伊马替尼治疗175例复发转移性GIST的临床资料,其中26例行中短期(2～6个月)连续CT复查者纳入研究。采用Siemens plus4单排螺旋CT及GE64排MDCT。轴位图像测量肿瘤最长径线及最大层面强化CT值,按照RECIST及Choi标准要求累加并平均得到病例长径及CT均值。计算治疗前后长径及CT值变化率,按照RECIST及Choi标准划分为缓解和无缓解两组。用Kaplan-Meier法判断不同标准分组肿瘤进展时间的差异,比较两个标准的应用价值。结果根据RECIST标准评价治疗缓解7例,无缓解19例,缓解率27%;根据Choi标准评价治疗缓解19例,无缓解7例,缓解率73%。病人中位随访时间23.5个月,截至2008年1月26例病人的中位肿瘤进展时间为17.5个月。根据RECIST标准评效,缓解组和无缓解组肿瘤进展时间差异无统计学意义(P=0.910);根据Choi标准评效,缓解组和无缓解组肿瘤进展时间差异有统计学意义(P<0.001)。结论Choi标准用于评价伊马替尼治疗GIST的早期疗效优于RECIST标准。
Objective To evaluate the value of RECIST and Choi criteria in the early evaluation of CT in the treatment of gastrointestinal stromal tumor (GIST) with imatinib. Methods The clinical data of 175 patients with relapsed and metastatic GIST treated with imatinib from School of Clinical Oncology, Peking University, from April 2003 to January 2008 were retrospectively analyzed. Among them, 26 patients underwent continuous and short-term CT examinations (2 to 6 months) Included in the study. Siemens plus4 single row spiral CT and GE64 row MDCT. Axial images measured the longest tumor diameter line and the largest level of enhanced CT value, according to RECIST and Choi standard cumulative requirements and average case diameter and CT mean. Calculate the diameter before and after treatment and the CT rate of change, according to RECIST and Choi criteria were divided into two groups of ease and no relief. Kaplan-Meier method to determine the difference between the different groups of tumor progression time, compare the value of the two standards. Results According to RECIST standard, 7 cases were treated with remission, 19 cases without remission and 27% remission rate. According to Choi criteria, 19 cases were treated with remission, 7 cases without remission and 73% remission rate. The median follow-up time was 23.5 months. As of January 2008, the median tumor progression time for 26 patients was 17.5 months. According to the RECIST criteria, there was no significant difference in the time of tumor progression between the remission group and the non-remission group (P = 0.910). According to the Choi standard, the difference of tumor progression time between remission group and non-remission group was statistically significant (P <0.001) ). Conclusion The Choi standard is superior to RECIST in evaluating the efficacy of imatinib in the treatment of GIST.