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

  • Computed Tomography
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Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Noemi Schmidt & Georg Bongartz

  2. Department of Medical Oncology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Viviane Hess

  3. Clinical Trial Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Thomas Zumbrunn

  4. Department of Medical Oncology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Christian Rothermundt

  5. Institute of Radiology, Spital Limmattal, Urdorferstrasse 100, 8952, Schlieren, Switzerland

    Silke Potthast

Authors
  1. Noemi Schmidt
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  2. Viviane Hess
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  3. Thomas Zumbrunn
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  4. Christian Rothermundt
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  5. Georg Bongartz
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  6. Silke Potthast
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Correspondence to Silke Potthast.

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Schmidt, N., Hess, V., Zumbrunn, T. et al. Choi response criteria for prediction of survival in patients with metastatic renal cell carcinoma treated with anti-angiogenic therapies. Eur Radiol 23, 632–639 (2013). https://doi.org/10.1007/s00330-012-2640-x

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  • DOI: https://doi.org/10.1007/s00330-012-2640-x

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