RECIST 1.1标准和mRECIST标准在原发性肝癌SBRT治疗后疗效评价中的对比研究

摘要

Objective: To compare the difference of Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) and modified Re-sponse Evaluation Criteria in Solid Tumors (mRECIST) in the treatment of hepatocellular carcinoma (HCC) after stereotactic body radio-therapy (SBRT). Methods:From Janurary 2014 to August 2015, thirty-five patients with HCC treated with SBRT were included in De-partment of Radiation Oncology and Integrative Oncology of Navy General Hospital of PLA, and SBRT efficacy was evaluated based on RECIST 1.1 and mRECIST criteria. Results:Under RECIST 1.1, one patient had complete response (CR), 20 had partial response (PR), and 11 achieved stable disease (SD) at three months. Three patients had progressive disease (PD). The overall best response rate (CR+PR) was 60%. In comparison, under mRECIST, 10 patients had CR, 16 had PR, and 6 achieved SD at three months. Three patients had PD. The overall best response rate was 74.28%. The statistical analysis showed that Kappa=0.402 (χ2=43.3, P<0. 001) was less than 0.75 but greater than 0.4, indicating that it had not reached the two diagnostic criteria of consistency degree of satisfaction. According to the mRECIST criteria, the objective remission group (CR+PR) was superior to the nonobjective remission group (SD+PD) in progression-free survival (P<0.001). Conclusion:For unresectable HCC, mRECIST may be more useful than RECIST 1.1 in evaluating HCC response to SBRT.%目的：回顾性分析对比研究实体瘤疗效评价标准1.1版（Response Evaluation Criteria in Solid Tumors1.1，RECIST 1.1）和修改后实体瘤疗效评价标准（modified Response Evaluation Criteria in Solid Tumors，mRECIST）在原发性肝癌射波刀治疗后疗效评价的差异。方法：回顾性分析2014年1月至2015年8月在安徽医科大学海军总医院治疗的原发性肝癌患者35例，分别按照RECIST 1.1标准和mRECIST标准评价立体定向放疗射波刀治疗后疗效。结果：按照RECIST 1.1标准，在射波刀治疗后3个月，全组35例患者完全缓解（complete response，CR）为1例、部分缓解（partial response，PR）为20例、疾病稳定（stable disease，SD）为11例、疾病进展（progressive disease，PD）为3例，近期有效率（CR+PR）60%，而按照mRECIST标准，在射波刀治疗后3个月，CR为10例、PR为16例、SD为6例、PD为3例，近期有效率（CR+PR）74.28%；经统计学分析Kappa=0.402（χ2=43.3，P<0.001），说明两个诊断标准一致性尚未达到满意程度。按照mRECIST标准，客观缓解组的患者（CR+PR）与非客观缓解组患者（SD+PD）在无进展生存期（progres⁃sion free survival，PFS）上显示优势（P<0.001）。结论：对于不可手术的原发性肝癌射波刀治疗后的疗效评价，mRECIST标准可能能够更好地区分不同患者的疗效，预测患者预后。