Choi response criteria for prediction of survival in patients with metastatic renal cell carcinoma treated with anti-angiogenic therapies.
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.
Department of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
Noemi
N
Schmidt
Viviane
V
Hess
Thomas
T
Zumbrunn
Christian
C
Rothermundt
Georg
G
Bongartz
Silke
S
Potthast
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors