mRECIST标准与RECIST标准评价经动脉化疗栓塞联合索拉非尼治疗不可切除肝细胞癌疗效的比较

A comparison of the mRECIST and RECIST criteria in the efficacy assessment of TACE combined with sorafenib in the treatment of unresectable hepatocellular carcinoma

目的评估mRECIST标准在评价经动脉化疗栓塞（TAcE）联合索拉非尼治疗肝细胞癌疗效中的价值。方法我院2011年6月至2012年11月共有35例采用TACE联合索拉非尼治疗的不可切除肝细胞癌患者符合mRECIST及RECIST疗效评价标准要求。患者影像学复查均采用增强CT和（或）增强MRI检查。评阅35例患者我院联合治疗前基线和治疗后3个月复查的影像学资料，分别使用mRECIST及RCIST标准评价疗效并对两种标准的评价结果进行比较。结果35例患者RECIST标准评估完全缓解（CR）0％，部分缓解（PR）2．9％，病变稳定（SD）85．7％，病变进展（PD）11．4％；mRECIST标准评估CR8．6％，PR51．4％，SD34．3％，PD5．7％。RECIST标准评价客观有效率（CR＋PR）2．9％，疾病控制率（CR＋PR＋SD）88．6％，疾病进展率11．4％；mRECIST标准评价客观有效率60％，疾病控制率94．3％，疾病进展率5．7％。两种标准疗效评价结果差异有统计学意义（P〈O．001）。结论mRECIST标准以“存活肿瘤”对靶病灶进行疗效评价更加可靠，更适应现今TAcE和靶向药物等具有新作用机制的治疗方法效果的评估。

Objective To evaluate the value of the mRECIST criteria in assessing the efficacy of transcatheter arterial chemoembolization（TACE） combined with sorafenib in the treatment of hepato cellular carcinoma （HCC）. Methods A total of 35 patients who were treated with a combination of TACE and sorafenib for unresectable hepatocellular carcinoma fulfilled the mRECIST and RECIST cri teria in our hospital from June 2011 to November 2012. Enhanced CT and/or enhanced MRI were used before （baseline） and after （3 month reexamination） combination treatment in our hospital. The mRECIST and RECIST criteria were used to evaluate the efficacy, and these efficacy assessments were compared. Results In the RECIST criteria, complete remission （CR） was 0%, partial remission （PR） was 2.9%, stable disease （SD） was 85.7%, and progressive disease （PD） was 11.40%. In the mRECIST criteria, CR was 8.6%, PR was 51.40%, SD was 34.3%, and PD was 5.7%. For the RECIST criteria, the objective response rate （CR＋PR） was 2.9%, the disease control rate （CR＋ PR＋SD） was 88.6%, and the disease progression rate was 11.4%. For the mRECIST criteria, the objective criteria was 60%, the disease control rate was 94.3%, and the disease progression rate was 5.7 %. The difference between the efficacy assessment results of mRECIST and RECIST was statisti- cally significant（P〈0. 001）. Conclusion The mRECIST criteria can evaluate the efficacy of target le sions based on viable tumors, which is more adaptive to TACE and targeted drugs with new mecha-nisms.