Value of first assessment by four response evaluation criteria in predicting the prognosis of patients with gastrointestinal stromal tumors receiving imatinib treatment: a comparative analysis

Yang Ping; Zhao Xiaofang; Tang Huali; Li Yi; Mao Yun

doi:10.13406/j.cnki.cyxb.003558

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Value of first assessment by four response evaluation criteria in predicting the prognosis of patients with gastrointestinal stromal tumors receiving imatinib treatment: a comparative analysis

Medical imaging | 更新时间：2025-10-21

- Value of first assessment by four response evaluation criteria in predicting the prognosis of patients with gastrointestinal stromal tumors receiving imatinib treatment: a comparative analysis
- Journal of Chongqing Medical University Vol. 49, Issue 8, Pages: 1045-1051(2024)
- 作者机构：
  
  重庆医科大学附属第一医院放射科，重庆 400016
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.003558
  CLC： R735;R445.3
- Received：30 October 2023，
  
  Revised：2024-02-03，
  
  Accepted：14 March 2024，
  
  Published：28 August 2024
- 稿件说明：
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杨萍,赵晓芳,唐华丽,等.比较4种疗效评估标准的首次评估在胃肠间质瘤伊马替尼治疗中的预后预测价值[J].重庆医科大学学报,2024,49(8):1045-1051.

Yang Ping,Zhao Xiaofang,Tang Huali,et al.Value of first assessment by four response evaluation criteria in predicting the prognosis of patients with gastrointestinal stromal tumors receiving imatinib treatment: a comparative analysis[J].Journal of Chongqing Medical University,2024,49(8):1045-1051.
杨萍,赵晓芳,唐华丽,等.比较4种疗效评估标准的首次评估在胃肠间质瘤伊马替尼治疗中的预后预测价值[J].重庆医科大学学报,2024,49(8):1045-1051. DOI： 10.13406/j.cnki.cyxb.003558.

Yang Ping,Zhao Xiaofang,Tang Huali,et al.Value of first assessment by four response evaluation criteria in predicting the prognosis of patients with gastrointestinal stromal tumors receiving imatinib treatment: a comparative analysis[J].Journal of Chongqing Medical University,2024,49(8):1045-1051. DOI： 10.13406/j.cnki.cyxb.003558.

摘要

目的

比较RECIST1.1、mRECIST1.1、Choi及早期形态学变化（early morphological change，EMC）4种疗效评估标准对接受伊马替尼（imatinib，IM）治疗的胃肠道间质瘤（gastrointestinal stromal tumors，GISTs）患者的预后预测能力，并分析不同疗效患者的手术时机。

方法

分别采用RECIST1.1、mRECIST1.1、Choi及EMC标准回顾性分析本院66例GISTs患者IM治疗前后的增强CT图像，并根据首次随访疗效反应将患者分为疗效good组和poor组。采用Kaplan-Meier生存曲线分别描绘四种疗效评估标准两组的总生存时间（overall survival，OS）和无进展生存时间（progression-free survival，PFS），通过log-rank检验比较OS及PFS是否存在组间差异。计算首次随访不同疗效患者在治疗后不同时间段的疾病进展（progressive disease，PD）及达到最佳疗效反应（best of response，BOR）的比例以确定合适的手术时机（在BOR比例≥50%且PD比例≤20%的前提下，患者最佳手术时机定义为两者差值最大的治疗时间段）。

结果

EMC标准首次随访疗效good组与poor组间OS（

=0.043）及PFS（

=0.003）差异均有统计学意义。Choi标准2组间仅PFS差异有统计学意义（

=0.002）。RECIST1.1

及mRECIST1.1标准首次随访疗效反应分组一致，2组间OS及PFS差异均无统计学意义（均

0.05）。EMC标准疗效good组即完全反应患者在治疗后1年内50%患者达BOR且无患者发生PD，该组最早PD时间为治疗后1.5年；并且完全反应患者手术与未手术组间的OS差异无统计学意义（

=0.051）。

结论

EMC标准能够早期、准确地对GISTs患者IM治疗后的预后进行分层；且依据EMC标准，完全反应患者可在治疗后1年再考虑手术切除，但这部分患者或许能够选择定期监测等更为保守的治疗措施来代替手术。

Abstract

Objective

To compare the performance of four response evaluation criteria，i.e.，RECIST1.1，mRECIST1.1，Choi，and early morphological change（EMC），in predicting the prognosis of patients with gastrointestinal stromal tumors（GISTs） receiving imatinib（IM） treatment，and to investigate the surgical timing of patients with different responses.

Methods

A retrospective analysis was performed for the contrast-enhanced computed tomography images of 66 patients with GISTs in our hospital before and after IM treatment using the four response evaluation criteria，and the patients were divided into good response group and poor response group based on the response of the first follow-up. The Kaplan-Meier survival curve was used to describe the overall survival（OS） and progression-free survival（PFS） of the two groups based on the four criteria，and the log-rank test was used for comparison of OS and PFS between groups. The proportion of patients with progressive disease（PD） or the best of response（BOR） at different periods of time after treatment were calculated to determine proper surgical timing（under the premise of ≥50% of the patients with BOR and ≤20% of the patients with PD，with the optimal surgical timing defined as the treatment period with the largest difference between BOR and PD）.

Results

There were significant differences in OS（

=0.043） and PFS（

=0.003） between the good response group and the poor response group according to the EMC criteria，while there was only a significant difference in PFS（

=0.002

） between the two groups based on the Choi criteria. The two groups divided based on the RECIST1.1 and mRECIST1.1 criteria were consistent，with no significant differences in OS and PFS between the two groups（

0.05）. According to the EMC criteria，50% of the patients in the good response group achieved BOR without PD within 1 year after treatment，and the earliest time to PD was 1.5 years after treatment； for the patients with complete response，there was no significant difference in OS between the surgery group and the non-surgery group（

=0.051）.

Conclusion

The EMC criteria can accurately stratify the prognosis of patients with GISTs in the early stage after IM treatment； according to the EMC criteria，resection can be considered for the patients with complete response after 1 year of treatment，and instead of surgery，these patients may choose more conservative treatment measures such as regular monitoring.

关键词

Keywords

references

Blay JY ， Kang YK ， Nishida T ， et al . Gastrointestinal stromal tumours [J ] . Nat Rev Dis Primers ， 2021 ， 7 （ 1 ）： 22 ．

von Mehren M ， Joensuu H . Gastrointestinal stromal tumors [J ] . J Clin Oncol ， 2018 ， 36 （ 2 ）： 136 - 143 ．

von Mehren M ， Kane JM ， Riedel RF ， et al . NCCN guidelines ® insights：gastrointestinal stromal tumors，version 2.2022 [J ] . J Natl Compr Canc Netw ， 2022 ， 20 （ 11 ）： 1204 - 1214 ．

中国临床肿瘤学会指南工作委员会 . 中国临床肿瘤学会（CSCO）胃肠间质瘤诊疗指南（2023） [J ] . 临床外科杂志， 2023 ， 30 （ 1 ）： 13 - 16 .

Guidelines Working Committee of Chinese Society of Clinical Oncology . Chinese Society of Clinical Oncology（CSCO) guidelines for the diagnosis and treatment of gastrointestinal stromal tumor（version2023） [J ] . Journal of Clinical Surgery ， 2023 ， 30 （ 1 ）： 13 - 16 .

Casali PG ， Blay JY ， Abecassis N ， et al . Gastrointestinal stromal tumours：ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis，treatment and follow-up [J ] . Ann Oncol ， 2022 ， 33 （ 1 ）： 20 - 33 ．

Rutkowski P ， Gronchi A ， Hohenberger P ， et al . Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors（GIST）：the EORTC STBSG experience [J ] . Ann Surg Oncol ， 2013 ， 20 （ 9 ）： 2937 - 2943 ．

Wang D ， Zhang Q ， Blanke CD ， et al . Phase II trial of neoadjuvant/adjuvant imatinib mesylate for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumors：long-term follow-up results of Radiation Therapy Oncology Group 0132 [J ] . Ann Surg Oncol ， 2012 ， 19 （ 4 ）： 1074 - 1080 ．

Peter H ， Claus L ， Martin WC ， et al . Neoadjuvant treatment of locally advanced GIST：results of APOLLON ，a prospective，open label phase Ⅱ study in KIT- or PDGFRA-positive tumors [J ] . J Clin Oncol ， 2012 ， 30 （ 15 ）： 10031 ．

曹晖，高志冬，何裕隆 . 胃肠间质瘤规范化外科治疗中国专家共识（2018版） [J ] . 中国实用外科杂志， 2018 ， 38 （ 9 ）： 965 - 73 .

Cao H ， Gao ZD ， Hy YL . Chinese expert consensus on standardized surgical treatment of gastrointestinal stromal tumors（version 2018) [J ] . Chin J Pract Surg ， 2018 ， 38 （ 9 ）： 965 - 73 .

徐泽宽，徐　皓，李沣员 . 腹腔镜技术在胃肠间质瘤手术中的应用价值与争议 [J ] . 中国实用外科杂志， 2018 ， 38 （ 5 ）： 501 - 504 ．

Xu ZK ， Xu H ， Li FY . Application value and controversy of laparoscopic surgery in gastric GIST [J ] . Chin J Pract Surg ， 2018 ， 38 （ 5 ）： 501 - 504 ．

Habr-Gama A ， Perez RO ， Nadalin W ， et al . Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy：long-term results [J ] . Ann Surg ， 2004 ， 240 （ 4 ）： 711 - 717 ．

van der Valk MJM ， Hilling DE ， Bastiaannet E ， et al . Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database（IWWD）：an international multicentre registry study [J ] . Lancet ， 2018 ， 391 （ 10139 ）： 2537 - 2545 ．

Eisenhauer EA ， Therasse P ， Bogaerts J ， et al . New response evaluation criteria in solid tumours：revised RECIST guideline（version 1.1） [J ] . Eur J Cancer ， 2009 ， 45 （ 2 ）： 228 - 247 ．

Shankar S ， VanSonnenberg E ， Desai J ， et al . Gastrointestinal stromal tumor：new nodule-within-a-mass pattern of recurrence after partial response to imatinib mesylate [J ] . Radiology ， 2005 ， 235 （ 3 ）： 892 - 898 ．

Demetri GD ， Reichardt P ， Kang YK ， et al . Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib（GRID）：an international，multicentre，randomised，placebo-controlled，phase 3 trial [J ] . Lancet ， 2013 ， 381 （ 9863 ）： 295 - 302 ．

Choi H ， Charnsangavej C ， de Castro Faria S ， et al . CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment：a quantitative analysis correlated with FDG PET findings [J ] . AJR Am J Roentgenol ， 2004 ， 183 （ 6 ）： 1619 - 1628 ．

Holdsworth CH ， Badawi RD ， Manola JB ， et al . CT and PET：early prognostic indicators of response to imatinib mesylate in patients with gastrointestinal stromal tumor [J ] . AJR Am J Roentgenol ， 2007 ， 189 （ 6 ）： W324 - W330 ．

Vanel D ， Albiter M ， Shapeero L ， et al . Role of computed tomography in the follow-up of hepatic and peritoneal metastases of GIST under imatinib mesylate treatment：a prospective study of 54 patients [J ] . Eur J Radiol ， 2005 ， 54 （ 1 ）： 118 - 123 ．

Choi H ， Charnsangavej C ， Faria SC ， et al . Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate：proposal of new computed tomography response criteria [J ] . J Clin Oncol ， 2007 ， 25 （ 13 ）： 1753 - 1759 ．

Ishida T ， Takahashi T ， Nishida T ， et al . New response evaluation criteria using early morphological change in imatinib treatment for patients with gastrointestinal stromal tumor [J ] . Gastric Cancer ， 2022 ， 25 （ 1 ）： 218 - 225 ．

Chun YS ， Vauthey JN ， Boonsirikamchai P ， et al . Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases [J ] . JAMA ， 2009 ， 302 （ 21 ）： 2338 - 2344 ．

Landis JR ， Koch GG . The measurement of observer agreement for categorical data [J ] . Biometrics ， 1977 ， 33 （ 1 ）： 159 - 174 ．

Casali PG ， Abecassis N ， Aro HT ， et al . Gastrointestinal stromal tumours：ESMO-EURACAN Clinical Practice Guidelines for diagnosis，treatment and follow-up [J ] . Ann Oncol ， 2018 ， 29 Suppl 4 ： S68 - S78 ．

Antoch G ， Kanja J ， Bauer S ， et al . Comparison of PET，CT，and dual-modality PET/CT imaging for monitoring of imatinib（STI571） therapy in patients with gastrointestinal stromal tumors [J ] . J Nucl Med ， 2004 ， 45 （ 3 ）： 357 - 365 ．

Rubbia-Brandt L ， Giostra E ， Brezault C ， et al . Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery [J ] . Ann Oncol ， 2007 ， 18 （ 2 ）： 299 - 304 ．

Alexandrescu ST ， Dumitru AV ， Babiuc RD ， et al . Assessment of clinical and pathological complete response after neoadjuvant chemoradiotherapy in rectal adenocarcinoma and its therapeutic implications [J ] . Rom J Morphol Embryol ， 2021 ， 62 （ 2 ）： 411 - 425 ．

Dossa F ， Chesney TR ， Acuna SA ， et al ． A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation：a systematic review and meta-analysis [J ] . Lancet Gastroenterol Hepatol ， 2017 ， 2 （ 7 ）： 501 - 513 ．

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