European Radiology

, Volume 23, Issue 3, pp 632–639 | Cite as

Choi response criteria for prediction of survival in patients with metastatic renal cell carcinoma treated with anti-angiogenic therapies

  • Noemi Schmidt
  • Viviane Hess
  • Thomas Zumbrunn
  • Christian Rothermundt
  • Georg Bongartz
  • Silke PotthastEmail author
Computed Tomography



Anti-angiogenic drugs cause a reduction in tumour density (Choi criteria) first and then in size [Response Evaluation Criteria In Solid Tumours (RECIST)]. The prognostic significance of changes in tumour density in metastatic renal cell carcinoma (mRCC) is unknown and was assessed in this study.


The prognostic significance of partial response (PR) as opposed to non-response [stable disease (SD) + progressive (PD)] to anti-angiogenic therapy was assessed in patients with mRCC separately for both criteria using the log-rank test and Cox regression models.


Both criteria were applied to 35 patients. The response was identical for all eight patients with PR and most patients with PD (10/12) when using the RECIST and Choi criteria. Adding tumour density information, 14 patients with SD were re-categorised as having PR (7), SD (4), and PD (3). Patients with PR (Choi) were progression free significantly longer [hazard ratio (HR) 0.24; 95 % CI 0.10–0.57; P = 0.001] and had better overall survival (HR 0.36; 95 % CI 0.15–0.89; P = 0.026) compared to patients with SD or PD. The predictive value of PR according to RECIST was not statistically significant.


In mRCC, the Choi criteria separate prognostic groups better when compared with RECIST. This may allow early discrimination of patients benefiting from continued treatment.

Key Points

CT is widely used to assess patients with metastatic renal cell carcinoma.

Various algorithms can be applied for tumour therapy control in patients with mRCC.

Follow-up should be based on evaluation of the tumour size and density.

RECIST is based only on tumour shrinkage and might lead to wrong conclusions.


Choi response criteria Metastatic renal cell cancer Prognostic factors RECIST CT 



The authors (SP and GB) thank Bayer Healthcare, Switzerland, for general support by an unrestricted research grant.


  1. 1.
    Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247PubMedCrossRefGoogle Scholar
  2. 2.
    Choi H, Charnsangavej C, Faria SC et al (2007) 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 Clin Oncol 25:1753–1759PubMedCrossRefGoogle Scholar
  3. 3.
    Siegel R, Naishadham D, Jemal A (2012) Cancer statistics. CA Cancer J Clin 62:10–29PubMedCrossRefGoogle Scholar
  4. 4.
    Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr (1999) Rising incidence of renal cell cancer in the United States. JAMA 281:1628–1631PubMedCrossRefGoogle Scholar
  5. 5.
    Escudier B, Eisen T, Stadler WM et al (2007) Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 356:125–134PubMedCrossRefGoogle Scholar
  6. 6.
    Motzer RJ, Hutson TE, Tomczak P et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356:115–124PubMedCrossRefGoogle Scholar
  7. 7.
    Motzer RJ, Escudier B, Oudard S et al (2008) Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet 372:449–456PubMedCrossRefGoogle Scholar
  8. 8.
    Hudes G, Carducci M, Tomczak P et al (2007) Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 356:2271–2281PubMedCrossRefGoogle Scholar
  9. 9.
    de Reijke TM, Bellmunt J, van Poppel H, Marreaud S, Aapro M (2009) EORTC-GU group expert opinion on metastatic renal cell cancer. Eur J Cancer 45:765–773PubMedCrossRefGoogle Scholar
  10. 10.
    Development Core Team R (2011) R: A Language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
  11. 11.
    Smith AD, Lieber ML, Shah SN (2010) Assessing tumor response and detecting recurrence in metastatic renal cell carcinoma on targeted therapy: importance of size and attenuation on contrast-enhanced CT. AJR Am J Roentgenol 194:157–165PubMedCrossRefGoogle Scholar
  12. 12.
    Smith AD, Shah SN, Rini BI, Lieber ML, Remer EM (2010) Morphology, Attenuation, Size, and Structure (MASS) criteria: assessing response and predicting clinical outcome in metastatic renal cell carcinoma on antiangiogenic targeted therapy. AJR Am J Roentgenol 194:1470–1478PubMedCrossRefGoogle Scholar
  13. 13.
    van der Veldt AAM, Meijerink MR, van den Eertwegh AJM, Haanen JB, Boven E (2010) Choi response criteria for early prediction of clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Br J Cancer 102:803–809PubMedCrossRefGoogle Scholar
  14. 14.
    Miles KA (1999) Tumour angiogenesis and its relation to contrast enhancement on computed tomography: a review. Eur J Radiol 30:198–205PubMedCrossRefGoogle Scholar
  15. 15.
    Miles KA, Charnsangavej C, Lee FT, Fishman EK, Horton K, Lee TY (2000) Application of CT in the investigation of angiogenesis in oncology. Acad Radiol 7:840–850PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Noemi Schmidt
    • 1
  • Viviane Hess
    • 2
  • Thomas Zumbrunn
    • 3
  • Christian Rothermundt
    • 4
  • Georg Bongartz
    • 1
  • Silke Potthast
    • 5
    Email author
  1. 1.Department of Radiology and Nuclear MedicineUniversity Hospital BaselBaselSwitzerland
  2. 2.Department of Medical OncologyUniversity Hospital BaselBaselSwitzerland
  3. 3.Clinical Trial UnitUniversity Hospital BaselBaselSwitzerland
  4. 4.Department of Medical OncologyCantonal Hospital St. GallenSt. GallenSwitzerland
  5. 5.Institute of RadiologySpital LimmattalSchlierenSwitzerland

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