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Defining disease status in gastroenteropancreatic neuroendocrine tumors: Choi-criteria or RECIST?

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Abstract

Purpose

Adequate monitoring of changes in tumor load is fundamental for the assessment of the course of disease and response to treatment. There is an ongoing debate on the utility of RECIST v1.1 in gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

Methods

In this retrospective real-life cohort study, Choi-criteria were compared with RECIST v1.1. The agreement between both criteria and the association with survival endpoints were evaluated.

Results

Seventy-five patients were included with a median follow-up of 35 months (range 8–53). Median progression-free survival (mPFS) according to RECIST v1.1 was 15 months (range 2–50) compared to 14 months (range 2–50) in Choi. According to RECIST, 33 (44%) patients were classified as having stable disease (SD), 40 (53%) as progressive disease (PD) and two (3%) patients as partial response (PR), compared to 9 (12%) patients classified as SD, 50 (67%) as PD and 16 (21%) as PR according to Choi-criteria. Overall concordance between the criteria was moderate (Cohen’s Kappa = 0.408, p < 0.001) and agreement varied between 57 and 69% at each consecutive scan (p < 0.001). Survival analysis showed significant differences in overall survival (OS) for RECIST v1.1 categories PD and non-PD (log-rank p = 0.02), however, in Choi no significant differences in OS were found (p = 0.27).

Conclusion

RECIST v1.1 had a better clinical utility and prognostic value compared to Choi-criteria. Still, RECIST were also not sufficient to adequately predict OS. This outlines the need for new tools that provides accurate information on the disease course and treatment response to support precise prognostication in patients with GEP-NETs.

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Acknowledgements

We would like to thank Marieke Ten Holter-Pieterman MA, MEd and Carla Pieterman, MD, PhD for proof-reading the manuscript.

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Authors and Affiliations

  1. Department of Endocrine Oncology, University Medical Center Utrecht Cancer Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands

    M. J. C. van Treijen, J. M. H. Schoevers & G. D. Valk

  2. The Netherlands Cancer Institute/University Medical Center Utrecht Center for Neuroendocrine Tumors, ENETs Center of Excellence, Amsterdam/Utrecht, The Netherlands

    M. J. C. van Treijen, B. C. Heeres, M. Maas, G. D. Valk & M. E. T. Tesselaar

  3. Department of Radiology, Bernhoven Hospital, Uden, The Netherlands

    D. van der Zee

  4. Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    B. C. Heeres & M. Maas

  5. Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    M. E. T. Tesselaar

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  1. M. J. C. van Treijen
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  2. J. M. H. Schoevers
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Contributions

MJCT and JMHS performed the analysis and wrote the manuscript with input from all authors. DZ and BCH reassessed all imaging studies. GDV, MM and METT supervised the project. All authors discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to M. J. C. van Treijen.

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The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. No funding was received for this study.

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van Treijen, M.J.C., Schoevers, J.M.H., Heeres, B.C. et al. Defining disease status in gastroenteropancreatic neuroendocrine tumors: Choi-criteria or RECIST?. Abdom Radiol 47, 1071–1081 (2022). https://doi.org/10.1007/s00261-021-03393-1

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  • DOI: https://doi.org/10.1007/s00261-021-03393-1

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