title: Significance of different response evaluation criteria in predicting progression-free survival of lung cancer with certain imaging characteristics.
abstract: BACKGROUND
  Certain radiographic signs of a treatment response, such as cavitation, changes in density, or tumor change along a short axis, are not considered by Response Evaluation Criteria in Solid Tumors (RECIST). This study evaluates what additional prognostic information can be obtained by including these criteria in tumor assessment.
  
  
  METHODS
  Data of 105 patients were included. Tumor cavitation was observed in 51 patients at baseline. An additional 23 patients developed tumor cavitation during treatment. A change in tumor density was the only radiographic treatment response observed in 22 patients. The only measureable treatment response in nine patients was a decrease along the short axis size of the tumor. Tumor response was assessed using various criteria.
  
  
  RESULTS
  In patients with basic tumor cavitation, RECIST1.1 scores accurately predicted differences in progression-free survival (PFS; P = 0.076) while modified (m) RECIST did not (P = 0.550). mRECIST detected a significant difference between PFS in patients with post-therapeutic cavitation with different responses, but no significant difference using RECIST1.1 (P = 0.004 vs. P = 0.477). In patients with only tumor density changes, there was no significant difference in PFS when either RECIST1.1 or density criteria were used (P = 0.419). In patients with a change in size along the tumor's short axis, short axis criteria could predict significant difference in PFS (P = 0.004).
  
  
  CONCLUSIONS
  RECIST1.1 provides the best assessment of tumor response and prediction of PFS in patients with basic tumor cavitation. mRECIST provides better PFS prognostic information in patients with post-therapeutic cavitation. Short axis criteria provides better PFS prognostic information in patients with changes in the short axis of tumor diameter. Changes in tumor density were not a useful prognostic sign.
authors.affiliation: Tianjin Taishan Cancer Hospital and International Personalized Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
authors.forename: Dengxia
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Gavitt
authors.initials: G
authors.lastname: Woodard
authors.affiliation: Department of Thoracic Oncology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
authors.forename: Chan
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Thoracic Oncology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
authors.forename: Xinyue
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Thoracic Oncology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
authors.forename: Zhujun
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Radiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
authors.forename: Zhaoxiang
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Department of Thoracic Oncology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D066066:Response Evaluation Criteria in Solid Tumors; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Cavitation; density; lung cancer; progression-free survival; short axis