Response Evaluation Criteria in Solid Tumors (RECIST) Quick Reference:Eligibility·  Only patients with measurable disease at baseline should be included in protocols where objective tumor response is the primary endpoint. Measurable disease - the presence of at least one measurable lesion. If the measurable disease is restricted to a solitary lesion, its neoplastic nature should be confirmed by cytology/histology. Measurable lesions - lesions that can be accurately measured in at least one dimension with longest diameter ³20 mm using conventional techniques or ³10 mm with spiral CT scan.Non-measurable lesions - all other lesions, including small lesions (longest diameter <20 mm with conventional techniques or <10 mm with spiral CT scan), i.e., bone lesions, leptomeningeal disease, ascites, pleural/pericardial effusion, inflammatory breast disease, lymphangitis cutis/pulmonis, cystic lesions, and also abdominal masses that are not confirmed and followed by imaging techniques; and.·  All measurements should be taken and recorded in metric notation, using a ruler or calipers. All baseline evaluations should be performed as closely as possible to the beginning of treatment and never more than 4 weeks before the beginning of the treatment. ·  The same method of assessment and the same technique should be used to characterize
each identified and reported lesion at baseline and during follow-up. ·  Clinical lesions will only be considered measurable when they are superficial (e.g., skin nodules and palpable lymph nodes). For the case of skin lesions, documentation by color photography, including a ruler to estimate the size of the lesion, is remended. Methods of Measurement – ·  CT and MRI are the best currently available and reproducible methods to measure target lesions selected for response assessment. Conventional CT and MRI should be performed with cuts of 10 mm or less in slice thickness contiguously. SpiralCT should be performed using a 5 mm contiguous reconstruction algorithm. This applies to tumors of the chest, abdomen and pelvis. Head and neck tumors and those of extremities usually require specific protocols.·  Lesions on chest X-ray are acceptable as measurable lesions when they are clearly defined and surrounded by aerated lung. However, CT is preferable. ·  When the primary endpoint of the study is objective response evaluation, ultrasound (US) should not be used to measure tumor lesions. It is, however, a possible alternative to clinical measurements of superficial palpable lymph nodes, subcutaneous lesions and thyroid nodules. US might also be useful to confirm the plete disappearance of superficial l
esions usually assessed by clinical examination.·  The utilization of endoscopy and laparoscopy for objective tumor evaluation has not yet been fully and widely validated. Their uses in this specific context require sophisticated equipment and a high level of expertise that may only be available in some centers. Therefore, the utilization of such techniques for objective tumor response should be restricted to validation purposes in specialized centers. However, such techniques can be useful in confirming plete pathological response when biopsies are obtained.·  Tumor markers alone cannot be used to assess response. If markers are initially above the upper normal limit, they must normalize for a patient to be considered in plete clinical response when all lesions have disappeared.·  Cytology and histology can be used to differentiate between PR and CR in rare cases (e.g., after treatment to differentiate between residual benign lesions and residual malignant lesions in tumor types such as germ cell tumors).Baseline documentation of “Target〞 and “Non-Target〞 lesions·  All measurable lesions up to a maximum of five lesions per organ and 10 lesions in total, representative of all involved organs should be identified as target lesions and recorded and measured at baseline. ·  Tar
get lesions should be selected on the basis of their size (lesions with the longest diameter) and their suitability for accurate repeated measurements (either by imaging techniques or clinically). ·  A sum of the longest diameter (LD) for all target lesions will be calculated and reported as the baseline sum LD. The baseline sum LD will be used as reference by which to characterize the objective tumor.所有目标病灶的最长长径总和将会被计算和汇报成基线的长径和，该和作为有效缓解记录的参考基线。·  All other lesions (or sites of disease) should be identified as non-target lesions and should also be recorded at baseline. Measurements of these lesions are not required, but the presence or absence of each should be noted throughout follow-up. Response CriteriaEvaluation of target lesions* plete Response (CR):  Disappearance of all target lesions* Partial Response (PR):  At least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD* Progressive Disease (PD):  At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions* Stable Disease (SD):  Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the
smallest sum LD since the treatment startedEvaluation of non-target lesions* plete Response (CR):  Disappearance of all non-target lesions and normalization of tumor marker level* Inplete Response/ Stable Disease (SD):   Persistence of one or more non-target lesion or/and maintenance of tumor marker level above the normal limits* Progressive Disease (PD):  Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions (1) (1)  Although a clear progression of “non target〞 lesions only is exceptional, in such circumstances, the opinion of the treating physician should prevail and the progression status should be confirmed later on by the review panel (or study chair).Evaluation of best overall responseThe best overall response is the best response recorded from the start of the treatment until disease progression/recurrence (taking as reference for PD the smallest measurements recorded since the treatment started). In general, the patient's best response assignment will depend on the achievement of both measurement and confirmation criteria Target lesions  Non-Target lesions  New Lesions  Overall responseCR  CR  No  CRCR  Inplete response/SD  No  PRPR  Non-PD  No  PRSD  Non-PD  No  SDPD  Any  Yes or No  PDAny  PD  Yes or N
o  PDAny  Any  Yes  PD·  Patients with a global deterioration of health status requiring discontinuation of treatment without objective evidence of disease progression at that time should be classified as having “symptomatic deterioration〞. Every effort should be made to document the objective progression even after discontinuation of treatment. ·  In some circumstances it may be difficult to distinguish residual disease from normal tissue. When the evaluation of plete response depends on this determination, it is remended that the residual lesion be investigated (fine needle aspirate/biopsy) to confirm the plete response status.Confirmation·  The main goal of confirmation of objective response is to avoid overestimating the response rate observed. In cases where confirmation of response is not feasible, it should be made clear when reporting the oute of such studies that the responses are not confirmed.·  To be assigned a status of PR or CR, changes in tumor measurements must be confirmed by repeat assessments that should be performed no less than 4 weeks after the criteria for response are first met. Longer intervals as determined by the study protocol may also be appropriate. ·  In the case of SD, follow-up measurements must have met the SD criteria at least once after study entry at a minimum i
nterval (in general, not less than 6-8 weeks) that is defined in the study protocol Duration of overall response·  The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever status is recorded first) until the first date that recurrence or PD is objectively documented, taking as reference for PD the smallest measurements recorded since the treatment started.Duration of stable disease·  SD is measured from the start of the treatment until the criteria for disease progression are met, taking as reference the smallest measurements recorded since the treatment started. ·  The clinical relevance of the duration of SD varies for different tumor types and grades. Therefore, it is highly remended that the protocol specify the minimal time interval required between two measurements for determination of SD. This time interval should take into account the expected clinical benefit that such a status may bring to the population under study. Response review·  For trials where the response rate is the primary endpoint it is strongly remended that all responses be reviewed by an expert independent of the study at the study’s pletion. Simultaneous review of the patients’ files and radiological images is the best approach. Reporting of results·  All patients included in the study must be assesse
d for response to treatment, even if there are major protocol treatment deviations or if they are ineligible. Each patient will be assigned one of the following categories: 1) plete response, 2) partial response, 3) stable disease, 4) progressive disease, 5) early death from malignant disease, 6) early death from toxicity, 7) early death because of other cause, or 9) unknown (not assessable, insufficient data).·  All of the patients who met the eligibility criteria should be included in the main analysis of the response rate. Patients in response categories 4-9 should be considered as failing to respond to treatment (disease progression). Thus, an incorrect treatment schedule or drug administration does not result in exclusion from the analysis of the response rate. Precise definitions for categories 4-9 will be protocol specific.·  All conclusions should be based on all eligible patients.·  Subanalyses may then be performed on the basis of a subset of patients, excluding those for whom major protocol deviations have been identified (e.g., early death due to other reasons, early discontinuation of treatment, major protocol violations, etc.). However, these subanalyses may not serve as the basis for drawing conclusions concerning treatment efficacy, and the reasons for excluding patients from the analysis should be clearly reported.
·  The 95% confidence intervals should be provided.RECIST (肿瘤疗效评价标准) 快速参考筛选条件：l  当客观肿瘤疗效是评价的主要终点时，只有在基线有可测量疾病的人可以包含到试验方案中。可测量疾病：至少有一个可测量病灶。如果该可测量性疾病仅限于一个孤立性病灶，那么该病灶性质应该被细胞学或者组织学确定。可测量病灶：至少有一个，用常规技术，病灶直径长度 ≥20mm，或螺旋CT ≥10mm的可以准确测量的病灶。不可测量病灶：所有其它病灶 (包括小病灶即常规技术长径 <20mm或螺旋CT <10mm ) 包括骨病灶、脑膜病变、腹水、胸水、炎症乳腺癌、皮肤或肺的癌性淋巴管炎、囊性病灶、影像学不能确诊和随诊的腹部肿块。 l  所有的测量在使用尺子或测径器测量后，应该用米制单位记录。基线的评价应该尽可能的在接近于开场的时候来执行，绝不能在开场前超过4周执行。l  基线和随诊应用同样的技术和方法评估病灶。l  临床表浅病灶如皮肤结节或可扪及的淋巴结可作为可测量病灶。皮肤病灶推荐应用有包括标尺测量尺寸的彩照片。测量方法l  对于判断可测量的目标病灶评价疗效，CT和MRI是目前最好的并可重复随诊的方法。对于胸、腹、和盆腔，CT和MRI用10mm或更薄的层面扫描，螺旋CT用5mm层面连续扫描，而头颈部及特殊部位要用特殊的方案。l  胸部X片： 有清晰明确的病灶可作为可测量病灶，但最好用CT扫描。l  超声捡查：当研究的主要终点是客观肿瘤疗效时，超声波不能用于测量肿瘤病灶，仅
可用于测量表浅可扪及的淋巴结、皮下结节和甲状腺结节，亦可用于确认临床查体后浅表病灶的完全消失。l  内窥镜和腹腔镜：作为客观肿瘤疗效评价至今尚未广泛充分的应用和验证，仅在有争议的病灶或有明确验证目的高水平的研究中心中应用。这种方法取得的活检标本可证实病理组织上的CR。l  肿瘤标志物：不能单独应用判断疗效。但前肿瘤标志物高于正常水平时且其他病灶消失，临床评价CR 时，所有的标志物需恢复正常。l  细胞学和病理组织学：在少数病例，细胞学和病理组织学可用于鉴别CR 和PR，区分后的良性病变还是残存的恶性病变。中出现的任何渗出，需细胞 学区别肿瘤的缓解、稳定及进展。目标和非目标肿瘤病灶基线的书面记录l  应代表所有累及的器官，每个脏器最多5个病灶，全部病灶总数最多10个的可测量目标病灶作为目标病灶，并在基线时测量并记录。l  目标病灶应根据病灶最长长径大小和可准确重复测量性〔影象技术或者是临床〕来选择。l  所有目标病灶的最长长径总和将会被计算和汇报成基线的长径和，该和作为有效缓解记录的参考基线。l  所有其它病灶应作为非目标病灶并在基线上记录，这些病灶不需测量，但是在随诊期间要注意其存在或消失。缓解的标准 目标病灶的评价CR ：所有目标病灶消失。PR ：基线病灶长径总和缩小 ≥ 30%。PD ：基线病灶长径总和增加 ≥ 20%或出现新病灶。SD ：基线病灶长径总和有缩小但未达PR或有增加但未达PD。非目标病灶的评价CR ：所有非目标病灶消
失和肿瘤标志物水平正常。SD ：一个或多个非目标病灶和/或肿瘤标志物高于正常持续存在。PD ：出现一个或多个新病灶或/和存在非目标病灶进展。    虽然只有非目标病灶明确进展是罕见的，但在这种情况下，医生的观点是主要的，并且进展情况应由整个研究小组确认。〔Although a clear progression of “non target〞 lesions only is exceptional, in such circumstances, the opinion of the treating physician should prevail and the progression status should be confirmed later on by the review panel (or study chair)slice中文〕.最正确总疗效评价最正确疗效评估是指开场后到疾病进展/复发 ( 开场最小测量记录作为进展的参考 )的最正确疗效记录。总的来说，病人最正确疗效的认定应取决于测量和确认标准的结果。目标病灶   非目标病灶  新病灶  总疗效CR  CR  无  CRCR  未达CR/SD  无  PRPR  无PD  无  PRSD  无PD  无  SDPD  任何  有/无  PD任何  PD  有/无  PD任何  任何  有  PDl  虽然没有PD证据，但因全身情况恶化而停顿者应为“病症恶化〞并在停顿后详细记录肿瘤客观进展情况。l  在某些情况下，很难区分残存肿瘤病灶和正常组织，当评价CR时，推荐使用细针穿刺或活检检查残存病灶来确定CR。 确认l  客观疗效确认的目的是防止RR的偏高。当疗效确实认不能给出时，那么在报告此类研究的时候，要明确说明疗效不能够确定。l  CR、PR肿瘤测量的变化必须反复判断证实， 必须在首次评价至少4周后复核确认，由试验方案决
定的更长时间确实认同样也是适宜的。l  SD病人在后根据方案中给出的最少间隔〔一般不少于6~8周〕来进展跟踪测量，病灶测量至少有一次SD。缓解期l  缓解期是把开场后所记录的最小测量PD做参照，从首次测量CR或PR时直到首次疾病复发或进展被记载时。 稳定期 l  稳定期是把开场后所记录的最小测量做参照，是从开场到疾病进展的时间。l  稳定期与临床的相关性因不同的肿瘤类型、不同的分化程度而变化。因此，高度推荐临床研究方案中列明来决定稳定的两次测量之间的最小时间间隔。这个时间间隔应该把可以把病人带入实验的预期临床利益考虑进去。 疗效回忆l  对于CR、PR是主要的研究终点时，强调所有缓解都必须被研究外的独立专家委员会检查。同时要查看病人的档案以及放射图象。结果报告 l  试验中的所有病人包括偏离了方案或不合格的病人必须判断对的疗效，每个病人都必须按如下分类 1〕CR、2〕PR、3〕SD、4〕PD、5〕死于肿瘤、6〕死于毒性、7〕死于其它肿瘤、9〕不明 ( 没有足够的资料评估 )。l  所有符合标准合格的病人都应包括在RR的分析中，所有上述4-9类的病人都应考虑为失败。因此不正确的进度或者不正确的给药并不直接的导致病人从RR分析中排除。4-9类病人的准确定义应在方案中给出。l  结论是基于符合标准的病人。l  其后可在排除那些被发现重大违反方案的病人之后，在病人的不同亚中进一步分析〔如：死于其他原因，早期退出，重大违反方案〕。实际上，
这些子分析并不能作为得出有关疗效的结论的根底，另外，在分析中排除每一个病人的原因都应该清楚的列明。l  提供95%的可信限间隔。

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