Purpose: To compare revised Choi criteria that incorporate concurrent size and attenuation changes at early follow-up imaging with Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and original Choi criteria in stratification of clinical outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib.
Materials and Methods: Institutional review board approved this retrospective study and waived informed consent. Baseline and first follow-up computed tomographic scans in 69 patients (50 men, 19 women; mean age, 60.3 years; range, 19-83 years) with mRCC treated with sunitinib from October 1, 2008, to March 1, 2013, were evaluated for tumor response by using RECIST 1.1, original Choi criteria, and revised Choi criteria. Correlations with overall survival (OS) and progression-free survival (PFS) were compared and stratified according to each radiologic criteria with Kaplan-Meier and multivariate Cox regression analysis.
Results: Median follow-up time was 29.7 months (95% confidence interval [CI]: 18.9, 45.9). Response according to revised Choi criteria was independently correlated with OS (hazard ratio, 0.47 (95% CI: 0.23, 0.99); P = .046) and PFS (hazard ratio, 0.53 (95% CI: 0.29, 0.99); P = .047). Response according to RECIST was not significantly correlated with OS (hazard ratio, 0.65 (95% CI: 0.27, 1.58); P = .344) or PFS (hazard ratio, 0.89 (95% CI: 0.42, 1.91); P = .768). Response according to original Choi criteria was not significantly correlated with OS (hazard ratio, 0.60 (95% CI: 0.32, 1.11); P = .106) or PFS (hazard ratio, 0.59 (95% CI: 0.34, 1.02); P = .060). Median OS and PFS in responders according to revised Choi criteria was 39.4 months (95% CI: 9.1, upper limit not estimated) and 13.7 months (95% CI: 6.4, 24.6), respectively, compared with 12.8 months (95% CI: 8.7, 18.0) and 5.3 months (95% CI: 3.9, 8.4), respectively, in nonresponders.
Conclusion: Contemporaneous reduction in tumor size and attenuation were correlated with favorable clinical outcomes. Response according to revised Choi criteria showed better correlation with clinical outcomes compared with that according to RECIST or original Choi criteria in patients with mRCC treated with sunitinib.
Written by:
Thian Y, Gutzeit A, Koh DM, Fisher R, Lote H, Larkin J, Sohaib A. Are you the author?
Departments of Radiology and Medical Oncology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, England.
Reference: Radiology. 2014 May 26:132702.
doi: 10.1148/radiol.14132702
PubMed Abstract
PMID: 24869795
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