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CT features combined with RECIST 1.1 criteria improve progression assessments of sunitinib-treated gastrointestinal stromal tumors

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

A Commentary to this article was published on 13 November 2023

Abstract

Objectives

To explore the auxiliary value of combining CT features with existing response evaluation criteria in the prediction of progressive disease (PD) in gastrointestinal stromal tumors (GIST) patients treated with sunitinib.

Material and methods

Eighty-one patients with GISTs who received sunitinib were included in this retrospective multicenter study and divided into training and external validation cohorts. Progression at six months was determined as a reference standard. The predictive performance of the RECIST 1.1 and Choi criteria was compared. CT features at baseline and the first follow-up were analyzed. Logistic regression analyses were used to determine the most significant predictors and develop modified criteria.

Results

A total of 216 lesions showed a good response and 107 showed a poor response in 81 patients. The RECIST 1.1 criteria performed better than the Choi criteria in predicting progression (AUC, 0.75 vs. 0.69, = 0.04). The expanded/intensified high-enhancement area, blurred tumor-tissue interface, and progressive enlarged vessels feeding or draining the mass (EVFDM) differed significantly between lesions with good and poor responses in the training cohort (= 0.001, 0.003, and 0.000, respectively). Multivariate analysis revealed that the expanded/intensified high-enhancement area (= 0.001), progressive EVFDM (= 0.000), and RECIST PD (= 0.000) were independent predictive factors. Modified RECIST (mRECIST) criteria were developed and showed significantly higher AUCs in the training and external validation cohorts than the RECIST 1.1 criteria (training: 0.81 vs. 0.73, = 0.002; validation: 0.82 vs. 0.77, = 0.04).

Conclusion

The mRECIST criteria, combining CT features with the RECIST 1.1 criteria, demonstrated superior performance in the prediction of early progression in GIST patients receiving sunitinib.

Clinical relevance statement

The mRECIST criteria, which combine CT features with the RECIST 1.1 criteria, may facilitate the early detection of progressive disease in GIST patients treated with sunitinib, thereby potentially guiding the timely switch to late-line medications or combination with surgical excision.

Key Points

• The RECIST 1.1 criteria outperformed the Choi criteria in identifying progression of GISTs in patients treated with sunitinib.

• GISTs displayed different morphologic features on CT depending on how they responded to sunitinib.

• Combining CT morphologic features with the RECIST 1.1 criteria allowed for the prompt and accurate identification of progressing GIST lesions.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

CI:

Confidence interval

DCE-MRI:

Dynamic contrast-enhanced MRI

EVFDM:

Enlarged vessels feeding or draining the mass

GIST:

Gastrointestinal stromal tumors

mPD:

Modified progressive disease

mRECIST:

Modified Response Evaluation Criteria in Solid Tumors

NPV:

Negative predictive value

OR:

Odds ratio

OS:

Overall survival

PD:

Progressive disease

PPV:

Positive predictive value

PR:

Partial response

RECIST:

Response Evaluation Criteria in Solid Tumors

ROC:

Receiver operating characteristic

SD:

Stable disease

TKI:

Tyrosine kinase inhibitor

VTB:

Vascular tumor burden

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Funding

This study has received funding by Beijing Natural Science Foundation (No. Z180001; Z200015); National Natural Science Foundation of China (No. 91959205); Science Foundation of Peking University Cancer Hospital (JC202301); and PKU-Baidu Foundation (No. 2020BD027).

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Authors and Affiliations

Authors

Corresponding authors

Correspondence to Jian Li, Youwei Kou, Yongjian Zhou, Bo Zhang, Haoran Qian, Jiren Yu, Ye Zhou, Lei Tang or Xinhua Zhang.

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Guarantor

The scientific guarantor of this publication is Lei Tang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Xiaoting Li, Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), is the expert we consulted in statistics for the preparation of this manuscript and is one of the authors.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (Beijing Cancer Hospital).

Study subjects or cohorts overlap

Study subjects or cohorts have not been previously reported.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

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Li, J., Huang, S., Zhu, H. et al. CT features combined with RECIST 1.1 criteria improve progression assessments of sunitinib-treated gastrointestinal stromal tumors. Eur Radiol 34, 3659–3670 (2024). https://doi.org/10.1007/s00330-023-10383-y

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  • DOI: https://doi.org/10.1007/s00330-023-10383-y

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