Document Detail

Computed tomography RECIST assessment of histopathologic response and prediction of survival in patients with resectable non-small-cell lung cancer after neoadjuvant chemotherapy.
MedLine Citation:
PMID:  23287849     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: This study's objectives were to determine whether tumor response measured by computed tomography (CT) and evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) correlated with overall survival (OS) in patients with non-small-cell lung cancer (NSCLC) after neoadjuvant chemotherapy and surgical resection.
METHODS: We measured primary tumor size on CT before and after neoadjuvant chemotherapy in 160 NSCLC patients who underwent surgical resection. The relationship between CT-measured response (RECIST) and histopathologic response (≤ 10% viable tumor) and OS were assessed by Kaplan-Meier survival, univariable, and multivariable Cox proportional hazards regression.
RESULTS: There was a statistically significant association between CT-measured response (RECIST) and OS (p = 0.03). However, histopathologic response was a stronger predictor of OS (p = 0.002), with a more pronounced separation of the survival curves when compared with CT-measured response. In multivariable Cox regression analysis, only pathologic stage and histopathologic response were significant predictors of OS. A 41% overall discordance rate was noted between CT RECIST response and histopathologic response. CT RECIST classified as nonresponders a subset of patients with histopathologic response (8 out of 30 points, 27%) who demonstrated prolonged survival after neoadjuvant chemotherapy.
CONCLUSION: We were unable to show that CT RECIST is a reliable predictor of OS in patients with NSCLC undergoing surgical resection after neoadjuvant chemotherapy. The failure of CT RECIST to predict long-term outcome may be because of the inability of CT imaging to consistently identify patients with histopathologic response. CT RECIST may have only a limited role as an efficacy endpoint after neoadjuvant chemotherapy in patients with resectable NSCLC.
William N William; Apar Pataer; Neda Kalhor; Arlene M Correa; David C Rice; Ignacio I Wistuba; John Heymach; J Jack Lee; Edward S Kim; Reginald Munden; Kathryn A Gold; Vassiliki Papadimitrakopoulou; Stephen G Swisher; Jeremy J Erasmus;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer     Volume:  8     ISSN:  1556-1380     ISO Abbreviation:  J Thorac Oncol     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-18     Completed Date:  2013-07-18     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  101274235     Medline TA:  J Thorac Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  222-8     Citation Subset:  IM    
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MeSH Terms
Adenocarcinoma / drug therapy,  mortality*,  pathology
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Bridged Compounds / administration & dosage
Carcinoma, Non-Small-Cell Lung / drug therapy,  mortality*,  pathology
Carcinoma, Squamous Cell / drug therapy,  mortality*,  pathology
Chemotherapy, Adjuvant
Follow-Up Studies
Lung Neoplasms / drug therapy,  mortality*,  pathology
Middle Aged
Neoadjuvant Therapy*
Neoplasm Staging
Platinum / administration & dosage
Retrospective Studies
Survival Rate
Taxoids / administration & dosage
Tomography, X-Ray Computed*
Grant Support
Reg. No./Substance:
0/Bridged Compounds; 0/Taxoids; 1605-68-1/taxane; 49DFR088MY/Platinum

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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