改良RECIST评估方法对局部进展期胃癌新辅助化疗后疗效评估的探索  

A preliminary study of modified RECIST evaluation method in evaluating the efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer

作　　者：陈金湖 方燕红[1] 叶青[1] 李阳明[1] 刘声源 黄峰[1] CHEN Jinhu;FANG Yanhong;YE Qing;LI Yangming;LIU Shengyuan;HUANG Feng(Department of Gastrointestinal Surgical Oncology,Fujian Cancer Hospital/Clinical Oncology School of Fujian Medical University,Fuzhou 350014,China)

机构地区：[1]福建省肿瘤医院/福建医科大学肿瘤临床医学院胃肠肿瘤外科,350014福建福州

出　　处：《中国肿瘤外科杂志》2023年第5期501-506,共6页Chinese Journal of Surgical Oncology

摘　　要：目的探索临床上简便实用的局部进展期胃癌新辅助化疗后疗效评估方法。方法分析2016年1月至2020年12月期间福建省肿瘤医院收治的最大淋巴结短径≥1.5 cm并行新辅助化疗及手术治疗的局部进展期胃癌病例的临床资料,应用高分辨率CT测量最大淋巴结短径和胃部病灶最大厚度,分别以最大淋巴结短径和两者之和为评估值,建立两种影像学评估方法,mRECIST①和mRECIST②,分析两种改良影像学评估方法与RECIST1.1无瘤生存率(DFS)的相关性。结果79例患者纳入研究,共筛选出短径≥1.5 cm的转移性淋巴结103枚,淋巴结短径为2.0(1.5~4.6)cm。术前CT评估肿瘤最大厚度为1.3(0.5~3.5)cm,淋巴结短径为1.2(0.4~3.5)cm。依据RECIST1.1标准进行疗效评价,PR 52例(65.8%)、SD 25例(31.6%)、PD 2例(2.5%)。反应组(CR和PR组)和未反应组(SD和PD组)的3年DFS差异有统计学意义(53.4 vs.21.6%,P=0.001),反应组与未反应组的死亡风险比,差异有统计学意义(HR=0.386;95%CI:0.211~0.706,P=0.002)。依据mRECIST①标准进行疗效评价,PR 53例(67.1%)、SD 24例(30.4%)、PD 2例(2.5%);反应组和未反应组的3年无瘤生存率差异有统计学意义(52.3%vs.22.4%,P=0.003),反应组对未反应组的死亡风险比,差异有统计学意义(HR=0.413;95%CI:0.226~0.756,P=0.004)。依据mRECIST②标准进行疗效评价,PR 48例(60.8%)、SD 29例(36.7%)、PD 2例(2.5%);反应组和未反应组的3年DFS差异有统计学意义(59.0%vs.18.4%,P=0.001),反应组对未反应组的死亡风险比,差异有统计学意义(HR=0.376;95%CI:0.204~0.691,P=0.002)。结论采用最大淋巴结短径与胃部病灶最大厚度之和对局部进展期胃癌新辅助化疗后进行疗效评价优于只用最大淋巴结短径或淋巴结短径之和进行疗效评价,是一种可选用的简便有效的疗效评估方法。Objective To explore a simple,practical,and effective method to evaluate the efficacy of neoadjuvant chemotherapy for locally advanced gastric cancer.Methods The clinical data of locally advanced gastric cancer patients with a maximum short diameter of lymph node≥1.5 cm treated with neoadjuvant chemotherapy and surgery,who were admitted to Fujian Cancer Hospital from January 2016 to December 2020,were retrospectively analyzed,and the maximum short diameter of lymph node and the maximum thickness of gastric lesions were measured by high-resolution CT.Two imaging evaluation methods,mRECIST①and mRECIST②,were established with the maximum short diameter of the lymph node and the sum of the two as the evaluation value,respectively.The correlation of RECIST1.1 and the two modified imaging evaluation methods with disease-free survival(DFS)was analyzed.Results A total of 79 locally advanced gastric cancer cases with a maximum lymph node short diameter≥1.5 cm who underwent D2 surgery and/or extended resection after neoadjuvant chemotherapy were included,and 103 metastatic lymph nodes with short diameter≥1.5 cm were screened,with a median short diameter of 2.0(1.5-4.6)cm.Preoperative CT evaluation revealed a median maximum tumor thickness of 1.3(0.5-3.5)cm and a median lymph node short diameter of 1.2(0.4-3.5)cm.In this study,CR and PR cases were defined as response groups,while SD and PD cases were defined as non-response groups.According to the RECIST1.1 criteria,there were 52 cases of PR(65.8%),25 cases of SD(31.6%)and 2 cases of PD(2.5%).There was a significant difference in the 3-year disease-free survival rate between the response group and non-response group(53.4%vs.21.6%,P=0.001),and the difference in mortality risk ratio between the response group and the non-response group was statistically significant(HR=0.386;95%CI:0.211~0.706,P=0.002).According to the mRECIST①criteria,there were 53 cases of PR(67.1%),24 cases of SD(30.4%)and 2 cases of PD(2.5%).The difference in 3-year disease-free survival rates be

关 键 词：胃肿瘤 局部进展期 围手术期化疗 新辅助治疗 疗效评价 

分 类 号：R735.2[医药卫生—肿瘤]