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European Radiology

10-11-2023 | Sunitinib | Oncology

CT features combined with RECIST 1.1 criteria improve progression assessments of sunitinib-treated gastrointestinal stromal tumors

Authors: Jiazheng Li, Shaoqing Huang, Hui Zhu, Chunhui Shou, Tianyu Lin, Xiaonan Yin, Quanjian Zhu, Dongmei Sun, Xiaoting Li, Lin Shen, Jian Li, Youwei Kou, Yongjian Zhou, Bo Zhang, Haoran Qian, Jiren Yu, Ye Zhou, Lei Tang, Xinhua Zhang

Published in: European Radiology

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Abstract

Objectives

To explore the auxiliary value of combining CT features with existing response evaluation criteria in the prediction of progressive disease (PD) in gastrointestinal stromal tumors (GIST) patients treated with sunitinib.

Material and methods

Eighty-one patients with GISTs who received sunitinib were included in this retrospective multicenter study and divided into training and external validation cohorts. Progression at six months was determined as a reference standard. The predictive performance of the RECIST 1.1 and Choi criteria was compared. CT features at baseline and the first follow-up were analyzed. Logistic regression analyses were used to determine the most significant predictors and develop modified criteria.

Results

A total of 216 lesions showed a good response and 107 showed a poor response in 81 patients. The RECIST 1.1 criteria performed better than the Choi criteria in predicting progression (AUC, 0.75 vs. 0.69, p = 0.04). The expanded/intensified high-enhancement area, blurred tumor-tissue interface, and progressive enlarged vessels feeding or draining the mass (EVFDM) differed significantly between lesions with good and poor responses in the training cohort (p = 0.001, 0.003, and 0.000, respectively). Multivariate analysis revealed that the expanded/intensified high-enhancement area (p = 0.001), progressive EVFDM (p = 0.000), and RECIST PD (p = 0.000) were independent predictive factors. Modified RECIST (mRECIST) criteria were developed and showed significantly higher AUCs in the training and external validation cohorts than the RECIST 1.1 criteria (training: 0.81 vs. 0.73, p = 0.002; validation: 0.82 vs. 0.77, p = 0.04).

Conclusion

The mRECIST criteria, combining CT features with the RECIST 1.1 criteria, demonstrated superior performance in the prediction of early progression in GIST patients receiving sunitinib.

Clinical relevance statement

The mRECIST criteria, which combine CT features with the RECIST 1.1 criteria, may facilitate the early detection of progressive disease in GIST patients treated with sunitinib, thereby potentially guiding the timely switch to late-line medications or combination with surgical excision.

Key Points

• The RECIST 1.1 criteria outperformed the Choi criteria in identifying progression of GISTs in patients treated with sunitinib.
• GISTs displayed different morphologic features on CT depending on how they responded to sunitinib.
• Combining CT morphologic features with the RECIST 1.1 criteria allowed for the prompt and accurate identification of progressing GIST lesions.
Appendix
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Metadata
Title
CT features combined with RECIST 1.1 criteria improve progression assessments of sunitinib-treated gastrointestinal stromal tumors
Authors
Jiazheng Li
Shaoqing Huang
Hui Zhu
Chunhui Shou
Tianyu Lin
Xiaonan Yin
Quanjian Zhu
Dongmei Sun
Xiaoting Li
Lin Shen
Jian Li
Youwei Kou
Yongjian Zhou
Bo Zhang
Haoran Qian
Jiren Yu
Ye Zhou
Lei Tang
Xinhua Zhang
Publication date
10-11-2023
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-10383-y