title: Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early response to chemotherapy in patients with non-small-cell lung cancer.
abstract: OBJECTIVE
  To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the European Organization for Research and Treatment of Cancer (EORTC) criteria and the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0 using PET volume computer-assisted reading (PET VCAR) for response evaluation in patients with advanced non-small-cell lung cancer (NSCLC) treated with chemotherapy.
  
  
  METHODS
  A total of 35 patients with NSCLC were included in this prospective study. All patients received standard chemotherapy and underwent (18)F-FDG PET/CT scans before and after treatment. With the assistance of PET VCAR, the chemotherapeutic responses were evaluated according to the RECIST 1.1, EORTC criteria and PERCIST 1.0. Concordance among these protocols was assessed using Cohen's κ coefficient and Wilcoxon's signed-ranks test. Progression-free survival (PFS) was calculated using the Kaplan-Meier test.
  
  
  RESULTS
  RECIST 1.1 and EORTC response classifications were discordant in 20 patients (57.1 %; κ = 0.194, P < 0.05), and RECIST 1.1 and PERCIST 1.0 classifications were discordant in 22 patients (62.9 %; κ = 0.139, P < 0.05). EORTC and PERCIST 1.0 classifications were discordant in only 4 patients (11.4 %), resulting in better concordance (κ = 0.804, P > 0.05). Patients with a partial remission according to RECIST 1.1 had significantly longer PFS (P < 0.001) than patients with progressive disease, but not significantly longer than patients with stable disease (P = 0.855). According to both the EORTC criteria and PERCIST 1.0, patients with a partial metabolic response had a significantly longer PFS than those with stable metabolic disease and those with progressive metabolic disease (P = 0.020 and P < 0.001, respectively, for EORTC; both P < 0.001 for PERCIST 1.0).
  
  
  CONCLUSIONS
  EORTC criteria and PERCIST 1.0 are more sensitive and accurate than RECIST 1.1 for the detection of an early therapeutic response to chemotherapy in patients with NSCLC. Although EORTC criteria and PERCIST 1.0 showed similar results, PERCIST 1.0 is preferred because detailed and unambiguous definitions are given. We also found that response evaluations with PERCIST 1.0 using a single lesion and multiple lesions gave similar response classifications.
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Jingjie
authors.initials: J
authors.lastname: Shang
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Xueying
authors.initials: X
authors.lastname: Ling
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Linyue
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Yongjin
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Zeyu
authors.initials: Z
authors.lastname: Xiao
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Guo
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Gong
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China. txh@jnu.edu.cn.
authors.forename: Hao
authors.initials: H
authors.lastname: Xu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D038622:Internationality; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D017410:Practice Guidelines as Topic; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D066066:Response Evaluation Criteria in Solid Tumors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: EORTC; Non-small cell lung cancer; PERCIST; RECIST; Response evaluation