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1、实体瘤疗效评价标准RECIST RECIST （Response Evaluation Criteria in Solid TumorsResponse Evaluation Criteria in Solid Tumors）RECIST 1.12018年1月15日星期一1实体瘤疗效评价的发展TUMOR RESPONSE CRITERIA WORLD HEALTH ORGANIZATION (WHO) WHO Handbook for Reporting Results of Cancer Treatment World Health Organization Offset Publicati
2、on No. 48Geneva, Switzerland, 1979Reporting Results of Cancer TreatmentAB Miller, B Hogestraeten, M Staquet, A WinklerCancer 47:20714, 1981RESPONSE EVALUATION CRITERIA IN SOLID TUMORS (RECIST) 1.0P Therasse, SG Arbuck, EA Eisenhauer, Journal of the National Cancer Institute 92: 205-216, 2000RECIST 1
3、.1Eisenhauera, et al, EJC, 2009 2000年美国NCI等正式发表RECIST标准： 采用单径测量代替双径测量 保留WHO标准中的CR、PR、SD、PD概念 相比WHO标准，更精确、简便、重复性好，同时增加了治疗机会，进行全面评估，并引进了影像学新概念。RECIST 标准：以肿瘤单径变化作为判断疗效的 标准特点疗效不足测量肿瘤最大长径CR: 所有目标病灶消失 PR :基线病灶长径总和缩小30% SD: 缩小未达PR或增加未到PD PD: 病灶长径总和增加 20%或出现新病灶1. 当肿瘤形态不规则或瘤 体在治疗后发生不均匀 性退缩时,是否还适用未 知 2. 以稳定肿瘤
4、细胞为主要 目的的分子靶向药物及 介入治疗，RECIST并 不完全适用（双径乘积增大25%，相当于体 积增大43%），过高评定PD（ 假性进展），使得一些病人过 早地失去了治疗机会RECIST: Response Evaluation Criteria in Solid Tumors疗效 RECIST评价 指标肿瘤最大径用常规方法测量 20mm；螺旋CT测量 10mmCR所有靶病变完全消失PR靶病变最大径之和缩小30%SD变化处于部分缓解和进展之间PD靶病变最大径之和增大20% 或出现新病灶http:/RECIST 1.0标准RECIST 1.1标准测量病灶的数目每个器官最多5个，总数不超过1
5、0个每个器官最多2个靶病灶，总数不超过5个淋巴结未指定靶病灶短径15mm，良性病灶5mm:5mm:层厚层厚* *2 2体检：体检：10mm10mm胸胸X X片：片：20mm20mm淋巴结淋巴结SAD 15mmSAD 15mmCTCT：Slice thickness 5mmSlice thickness 5mm不可测量病灶小病灶小病灶2L/W2 、非实性、非实性靶向治疗后改变：囊性，靶向治疗后改变：囊性， 坏死，出血，空洞等坏死，出血，空洞等肿瘤异质性肿瘤异质性RECIST：局限性？ 靶病灶选择数目？靶病灶选择数目？ 测量误差（测量误差（Intra- and inter-reader Intra
6、- and inter-reader variabilityvariability） 不同时检测的误差不同时检测的误差 Repeat lung CT scans taken 15 minutes later, Repeat lung CT scans taken 15 minutes later, 84% of lung were + 10% 84% of lung were + 10% ， 3% were sufficiently 3% were sufficiently different that an apparent PD would be recordeddifferent tha
7、t an apparent PD would be recorded 代谢学评价？代谢学评价？衍生的评价标准MPMMPM：mRECIST mRECIST 肝癌：肝癌：EASL EASL、mRECISTmRECIST、RECICLRECICLGISTGIST：ChoiChoi肾癌：肾癌：SACTSACT，MASSMASS脑膜瘤：脑膜瘤：RANORANO，MacdonaldMacdonaldMetabolic response criteriaMetabolic response criteria PETPET：EORTCEORTC， PERCIST PERCIST免疫治疗：免疫治疗：irRC (immune-related irRC (immune-related Response Criteria)Response Criteria)，mWHOmWHOThank you!Thank you!
