Optimization of response classification criteria for patients with malignant pleural mesothelioma.
Optimization of response classification criteria for patients with malignant pleural mesothelioma.
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DOI：
10.1097/jto.0b013e318269fe21
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发表时间：
2012-11
期刊：
影响因子：
--
通讯作者：
Nowak AK
中科院分区：
文献类型：
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作者：
Labby ZE;Armato SG 3rd;Kindler HL;Dignam JJ;Hasani A;Nowak AK
反应评估指标在临床试验和常规患者管理中发挥着重要作用。对于恶性胸膜间皮瘤（MPM）患者，反应评估的标准是根据修订后的RECIST（实体肿瘤反应评价标准）方案进行基于图像的肿瘤厚度测量。为了对肿瘤反应进行分类，肿瘤厚度的变化分别与标准RECIST的部分缓解（PR）和进展性疾病（PD）的- 30%和+20%切点进行比较，这两种切点对MPM没有特异性。这项工作的目的是通过评估MPM中现有反应标准的有效性，并提出替代标准，来优化肿瘤反应与患者生存之间的相关性。在基线和整个治疗过程中，78名接受标准护理化疗的患者获得了肿瘤厚度的CT测量。采用Harrell’s C统计，总生存率与最佳反应和首次随访反应相关。PD和PR的反应标准以1%的增量变化，以获得最佳的分类标准。使用留一方法交叉验证了性能。中位生存期为14.9个月。标准RECIST标准在反应与生存的相关性方面的表现为0.778，而优化的表现为PR为−64%，PD为+50%，表现为0.855。交叉验证后，该性能略有降低，为0.829。获得了新的MPM患者肿瘤反应分级标准。这些标准提高了基于图像的反应和患者生存之间的相关性。
Response assessment metrics play an important role in clinical trials and routine patient management. For patients with malignant pleural mesothelioma (MPM), the standard for response assessment is image-based measurements of tumor thickness made according to the modified RECIST (Response Evaluation Criteria in Solid Tumors) protocol. To classify tumor response, changes in tumor thickness are compared with the standard RECIST −30% and +20% cut-points for partial response (PR) and progressive disease (PD), respectively, which are not specific to MPM. The purpose of this work is to optimize the correlation between tumor response and patient survival by assessing the validity of existing response criteria in MPM, and proposing alternative criteria. CT measurements of tumor thickness were acquired at baseline and throughout treatment for 78 patients undergoing standard of care chemotherapy. Overall survival was correlated with best response and first follow-up response using Harrell’s C statistic. The response criteria for PD and PR were each varied in 1% increments to obtain the optimal classification criteria. The performance was cross-validated using a leave-one-out approach. Median survival was 14.9 months. The performance of the standard RECIST criteria in correlating response with survival was 0.778, while the optimized performance was obtained with criteria of −64% for PR and +50% for PD, yielding a performance of 0.855. After cross-validation, this performance was slightly reduced to 0.829. New tumor response classification criteria were obtained for patients with MPM. These criteria improve the correlation between image-based response and patient survival.