The value of enhanced CT volumetric measurement compared with RECIST 1.1 criteria in evaluating the efficacy of neoadjuvant chemotherapy combined with immunotherapy for gastric cancer

IF 2.3 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Abdominal Radiology Pub Date : 2026-04-12 DOI:10.1007/s00261-026-05425-0

Jie Chen, Yang Liu, Zhidong Zhang, Weishuai Zhang, Chenyu Hou, Zicheng Bao, Yushuo Cao

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引用次数: 0

Abstract

Objective

To explore the value of tumor volume reduction rate (VRR) measured by enhanced CT, compared with RECIST 1.1 criteria, in evaluating the efficacy of neoadjuvant chemotherapy combined with immunotherapy(NACI) for patients with locally advanced gastric cancer (LAGC), and its impact on prognosis.

Methods

This retrospective study included 107 gastric adenocarcinoma patients. VRR and RECIST 1.1 response were calculated from pre-treatment and post-treatment CT. Interobserver agreement was evaluated using the intraclass correlation coefficient(ICC), while correlation with pathological tumor regression grade (TRG) and diagnostic performance (ROC analysis) were assessed. The optimal VRR cut-off was determined. Prognostic value was evaluated via survival analysis.

Results

The ICC for the tumor VRR was 0.966 (95% CI: 0.951–0.977), which was significantly higher than the ICC for the tumor longest diameter reduction rate (0.701, 95% CI: 0.590–0.785). VRR showed a moderate negative correlation with TRG (r= -0.389, P < 0.001), which was significantly better than the weak correlation between RECIST 1.1 and TRG (r = 0.196, P = 0.043). The area under the curve (AUC) for VRR in predicting major pathological response was significantly higher (AUC = 0.7953) than that for RECIST 1.1 (AUC = 0.6127, P = 0.0017). Survival analysis showed that grouping based on VRR (2-year PFS: 69.4% vs. 37.8%, P = 0.018) and TRG (2-year PFS: 82.8% vs. 46.2%, P = 0.0029) significantly distinguished patient prognosis, whereas RECIST 1.1 criteria did not (P = 0.74). The combined model integrating VRR and TRG failed to provide more refined prognostic stratification. Among patients with TRG 2–3, whether VRR was greater than 47.4% did not significantly stratify prognosis (P = 0.7935).

Conclusions

(1) The tumor VRR demonstrates significantly superior observer agreement compared to the RECIST 1.1 criteria. (2) The correlation with TRG and diagnostic efficacy of VRR before and after neoadjuvant chemotherapy combined with immunotherapy are significantly superior to RECIST 1.1 criteria. (3) Regarding 2-year PFS, both VRR and TRG are effective indicators for prognostic evaluation after this treatment regimen, whereas RECIST 1.1 criteria lack statistical significance for 2-year PFS. (4) The combined model of VRR and TRG did not enable more precise prognostic stratification, indicating a need for further research.

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增强CT体积测量与RECIST 1.1标准在评价胃癌新辅助化疗联合免疫治疗疗效中的价值比较

目的：探讨增强CT测量肿瘤体积缩小率（VRR）与RECIST 1.1标准比较在评价局部晚期胃癌（LAGC）患者新辅助化疗联合免疫治疗（NACI）疗效中的价值及其对预后的影响。方法：对107例胃腺癌患者进行回顾性研究。通过治疗前和治疗后CT计算VRR和RECIST 1.1响应。使用类内相关系数（ICC）评估观察者间的一致性，同时评估与病理肿瘤消退等级（TRG）和诊断性能（ROC分析）的相关性。确定了最佳VRR截止值。通过生存分析评估预后价值。结果：肿瘤VRR的ICC值为0.966 (95% CI: 0.951 ~ 0.977)，显著高于肿瘤最长径缩小率的ICC值（0.701,95% CI: 0.590 ~ 0.785）。VRR与TRG呈中度负相关（r= -0.389， P）结论：(1)与RECIST 1.1标准相比，肿瘤VRR具有明显更好的观察者一致性。(2)新辅助化疗联合免疫治疗前后VRR与TRG的相关性及诊断效能均显著优于RECIST 1.1标准。(3)对于2年PFS， VRR和TRG均是评价该治疗方案后预后的有效指标，而RECIST 1.1标准对2年PFS缺乏统计学意义。(4) VRR和TRG联合模型不能实现更精确的预后分层，需要进一步研究。

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来源期刊

Abdominal Radiology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

8.30%

发文量

334

期刊介绍： Abdominal Radiology seeks to meet the professional needs of the abdominal radiologist by publishing clinically pertinent original, review and practice related articles on the gastrointestinal and genitourinary tracts and abdominal interventional and radiologic procedures. Case reports are generally not accepted unless they are the first report of a new disease or condition, or part of a special solicited section. Reasons to Publish Your Article in Abdominal Radiology: · Official journal of the Society of Abdominal Radiology (SAR) · Published in Cooperation with: European Society of Gastrointestinal and Abdominal Radiology (ESGAR) European Society of Urogenital Radiology (ESUR) Asian Society of Abdominal Radiology (ASAR) · Efficient handling and Expeditious review · Author feedback is provided in a mentoring style · Global readership · Readers can earn CME credits