不可手术切除的肝细胞癌的疗效评价标准——改良RECIST标准更可靠

Therapeutic evaluation criterion of inoperable hepatocellular carcinomas:modified RECIST as a more reliable standard

目前,临床上对于不可手术切除的肝细胞癌的治疗多采用介入疗法,近几年兴起的分子靶向药物索拉非尼在治疗中也占有一席之地。介入治疗和分子靶向药物治疗的作用机制均为导致肿瘤坏死,但病灶总体积往往保持不变甚至增大,采用传统的实体瘤的疗效评估标准(response evaluation criteriain solid tumor,RECIST)已不能满足准确、全面评估其疗效的需求,常出现低估疗效或假阳性进展的结果。改良RECIST标准以"存活肿瘤"对靶病灶进行疗效评价,能更准确、全面地评价肿瘤内部的变化。对于介入治疗和靶向药物等治疗,改良RECIST标准的评估结果更可靠。

Nowadays, interventional therapy is the most popular treatment for inoperable hepatocellular carcinomas. For recent years, Sorafenib, used as a molecular targeting drug, has been employed in the clinical practice, and at present it has already occupied a certain tiny space in the treatment of hepatocellular carcinomas. The anti-tumor mechanism of both interventional therapy and molecular targeting drugs is to cause tumor necrosis. Nevertheless, after the treatment the total volume of the lesions usually remains the same as that before the treatment, or even becomes enlarged. Therefore, traditional response evaluation criterion in solid tumor （RECIST） can＇t accurately and comprehensively assess the therapeutic efficacy, as REC1ST frequently underestimates the clinical efficacy or even makes a false judgment of positive progress. Modified RECIST evaluates the lesion＇s response based on the index of ＂viable tumor＂. Therefore, modified RECIST can assess the changes within the tumor more precisely and more comprehensively. Thus, the more reliable judgment for the therapeutic results of interventional therapy and targeting drug can be obtained. （J Intervent Radiol. 2012. 21： 177-179）