diff --git a/IRaCIS.Core.Application/Service/ReadingCalculate/Dto/CriterionCalculateDto.cs b/IRaCIS.Core.Application/Service/ReadingCalculate/Dto/CriterionCalculateDto.cs
index b0435897e..c7f2c9b26 100644
--- a/IRaCIS.Core.Application/Service/ReadingCalculate/Dto/CriterionCalculateDto.cs
+++ b/IRaCIS.Core.Application/Service/ReadingCalculate/Dto/CriterionCalculateDto.cs
@@ -105,6 +105,11 @@ namespace IRaCIS.Core.Application.ViewModel
         /// </summary>
         public bool BaseLineLessThan30 { get; set; }
 
+        /// <summary>
+        /// 非靶病灶中淋巴结病灶全部消失
+        /// </summary>
+        public bool NoTargetLymphLoss { get; set; }
+
     }
 
     /// <summary>
@@ -187,6 +192,16 @@ namespace IRaCIS.Core.Application.ViewModel
         /// 至少有一个新靶病无法评估
         /// </summary>
         public bool ExixtsUnevaluableState { get; set; }
+
+        /// <summary>
+        /// 当有“存在”状态的淋巴结新靶病灶
+        /// </summary>
+        public bool ExixtsLymphTarget { get; set; }
+
+        /// <summary>
+        /// 当有“存在”或“太小”状态的非淋巴结新靶病灶
+        /// </summary>
+        public bool ExixtsOrLessNoLymphTarget{ get; set; }
     }
 
     /// <summary>
diff --git a/IRaCIS.Core.Application/Service/ReadingCalculate/IRECIST1Point1CalculateService.cs b/IRaCIS.Core.Application/Service/ReadingCalculate/IRECIST1Point1CalculateService.cs
index 7dfef8c98..2b55ba542 100644
--- a/IRaCIS.Core.Application/Service/ReadingCalculate/IRECIST1Point1CalculateService.cs
+++ b/IRaCIS.Core.Application/Service/ReadingCalculate/IRECIST1Point1CalculateService.cs
@@ -487,11 +487,11 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                  // 与前一访视SOD相比变化量
                  new ReadingCalculateData (){QuestionType=QuestionType.LastVisitSODChange,GetDecimalNullFun=GetLastTaskSODChange,IsConvertedTask=true},
 
-                 //新靶病灶直径之和（iSOD）
+                 // 新靶病灶直径之和（iSOD）
                  new ReadingCalculateData (){QuestionType=QuestionType.ISOD,GetDecimalNullFun=GetiSODData,IsConvertedTask=true},
 
-                 // 与前一访视相比iSOD变化量
-                new ReadingCalculateData (){QuestionType=QuestionType.LastVisitiSODChange,GetDecimalNullFun=GetISODChange,IsConvertedTask=true},
+                 //  与触发iRECIST访视相比iSOD变化量
+                new ReadingCalculateData (){QuestionType=QuestionType.ComparedTriggeringiSODChange,GetDecimalNullFun=GetComparedTriggeringiSODChange,IsConvertedTask=true},
 
 				// 靶病灶评估
 			    new ReadingCalculateData (){QuestionType=QuestionType.TargetLesion,GetStringFun=GetTargetLesionEvaluate,IsConvertedTask=false},
@@ -578,7 +578,7 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                 List<QuestionType> questionTypes = new List<QuestionType>()
                 {
                     QuestionType.ISOD,
-                    QuestionType.LastVisitiSODChange,
+                    QuestionType.ComparedTriggeringiSODChange,
                     QuestionType.TargetLesion,
                     QuestionType.NoTargetLesion,
                     QuestionType.NewLesions,
@@ -1388,18 +1388,19 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
         }
         #endregion
 
-        #region 与前一访视相比iSOD变化量
+        #region 与触发iRECIST访视相比iSOD变化量
 
         /// <summary>
-        ///  与前一访视相比iSOD变化量
+        ///  与触发iRECIST访视相比iSOD变化量
         /// </summary>
         /// <param name="inDto"></param>
         /// <returns></returns>
-        public async Task<decimal?> GetISODChange(ReadingCalculateDto inDto)
+        public async Task<decimal?> GetComparedTriggeringiSODChange(ReadingCalculateDto inDto)
         {
 
-            var lastTaskId = await this.GetLastVisitTaskId(inDto);
-            var lastiSOD = (await _readingTaskQuestionAnswerRepository.Where(x => x.VisitTaskId == lastTaskId && x.ReadingQuestionTrial.QuestionType == QuestionType.ISOD).Select(x => x.Answer).FirstOrDefaultAsync()).IsNullOrEmptyReturn0();
+            var firstChangeTaskId = await GetFirstChangeTaskId(inDto);
+          
+            var firstChangeiSOD = (await _readingTaskQuestionAnswerRepository.Where(x => x.VisitTaskId == firstChangeTaskId && x.ReadingQuestionTrial.QuestionType == QuestionType.ISOD).Select(x => x.Answer).FirstOrDefaultAsync()).IsNullOrEmptyReturn0();
 
             var value = await GetiSODData(inDto);
 
@@ -1407,7 +1408,7 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
             {
                 return null;
             }
-            return value.NullChange0() - lastiSOD;
+            return value.NullChange0() - firstChangeiSOD;
         }
         #endregion
 
@@ -1702,10 +1703,10 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
         /// {
         ///     靶病灶疗效为 NE
         /// }
-        /// else if (所有非淋巴结靶病灶消失，径线总和为0 mm && 所有淋巴结靶病灶的短径缩小到 < 10 mm)
+        /// else if (所有非淋巴结靶病灶消失，径线总和为0 mm && 所有淋巴结靶病灶的短径缩小到 < 10 mm && 非靶病灶中淋巴结病灶全部消失)
         /// {
         ///     靶病灶疗效为 iCR
-        /// } else if (与基线期SOD相比减小≥30 %)
+        /// } else if (与基线期SOD相比减小≥30 %||(所有非淋巴结靶病灶消失，径线总和为0 mm && 所有淋巴结靶病灶的短径缩小到 < 10 mm&&非靶病灶中有淋巴结病灶为非消失))
         /// {
         ///     靶病灶疗效为 iPR
         /// }
@@ -1721,7 +1722,6 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
 
             var tableQuestion = inDto.QuestionInfo.Where(x => x.LesionType == LesionType.TargetLesion).SelectMany(x => x.TableRowInfoList).ToList();
             var lastVisitTaskId = await GetLastVisitTaskId(inDto);
-            var firstChangeTaskId = await GetFirstChangeTaskId(inDto);
             var targetLesionQuestionId = inDto.QuestionInfo.Where(x => x.QuestionType == QuestionType.TargetLesion).Select(x => x.QuestionId).FirstOrDefault();
 
             var sodQuestionId = inDto.QuestionInfo.Where(x => x.QuestionType == QuestionType.SOD).Select(x => x.QuestionId).FirstOrDefault();
@@ -1738,8 +1738,7 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                 MeetRECISTPD = (await GetTargetLesionEvaluate(inDto)) == TargetAssessment.PD.GetEnumInt(),
 
                 // 本次访视SOD与触发iRECIST访视相比本次访视SOD增加不小于5mm
-                SODTiggerAddGreaterThan5 = firstChangeTaskId==inDto.VisitTaskId ? false : await GetSODData(inDto) - (await _readingTaskQuestionAnswerRepository.Where(x => x.VisitTaskId == firstChangeTaskId && x.ReadingQuestionTrialId == sodQuestionId)
-                .Select(x => x.Answer).FirstOrDefaultAsync()).IsNullOrEmptyReturn0() >= 5,
+                SODTiggerAddGreaterThan5 = inDto.QuestionInfo.Where(x => x.QuestionType == QuestionType.ComparedTriggeringiSODChange).Sum(x => x.Answer.IsNullOrEmptyReturn0()) >= 5,
 
                 //比整体访视期间最低点SOD增加≥20 %
                 LowSodAddGreaterThan20Percent = inDto.QuestionInfo.Where(x => x.QuestionType == QuestionType.LowPercent).Sum(x => x.Answer.IsNullOrEmptyReturn0()) >= 20,
@@ -1761,8 +1760,22 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
 
                 // 与基线期SOD相比减小≥30 %
                 BaseLineLessThan30 = inDto.QuestionInfo.Where(x => x.QuestionType == QuestionType.SODPercent).Sum(x => x.Answer.IsNullOrEmptyReturn0()) <= -30,
+
+                //非靶病灶中淋巴结病灶全部消失
+                NoTargetLymphLoss = true,
             };
 
+            var noTargetTableQuestion = inDto.QuestionInfo.Where(x => x.LesionType == LesionType.NonTargetLesions).SelectMany(x => x.TableRowInfoList).ToList();
+
+            foreach (var item in noTargetTableQuestion)
+            {
+                if (item.TableQuestionList.Any(x => x.QuestionMark == QuestionMark.IsLymph && x.Answer.EqEnum(YesOrNoOrNa.Yes)))
+                {
+                   
+                    resultData.NoTargetLymphLoss = resultData.NoTargetLymphLoss && item.TableQuestionList.Where(x => x.QuestionMark == QuestionMark.State).Select(x => x.Answer).FirstOrDefault() == NoTargetState.Loss.GetEnumInt();
+
+                }
+            }
 
             foreach (var item in tableQuestion)
             {
@@ -1811,14 +1824,14 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                 //     靶病灶疗效为 NE
                 result = TargetAssessment.NE;
              }
-            // else if (所有非淋巴结靶病灶消失，径线总和为0 mm && 所有淋巴结靶病灶的短径缩小到 < 10 mm)
-            else if(resultData.AllLesionVanish&&resultData.AllMinorAxisLessThan10)
+            // else if (所有非淋巴结靶病灶消失，径线总和为0 mm && 所有淋巴结靶病灶的短径缩小到 < 10 mm && 非靶病灶中淋巴结病灶全部消失)
+            else if (resultData.AllLesionVanish&&resultData.AllMinorAxisLessThan10&& resultData.NoTargetLymphLoss)
             {
                 //     靶病灶疗效为 iCR
                 result = TargetAssessment.iCR;
             }
-            // else if (与基线期SOD相比减小≥30 %)
-            else if(resultData.BaseLineLessThan30)
+            // else if (与基线期SOD相比减小≥30 %||(所有非淋巴结靶病灶消失，径线总和为0 mm && 所有淋巴结靶病灶的短径缩小到 < 10 mm&&非靶病灶中有淋巴结病灶为非消失))
+            else if (resultData.BaseLineLessThan30||(resultData.AllLesionVanish && resultData.AllMinorAxisLessThan10 && !resultData.NoTargetLymphLoss))
              {
                 //     靶病灶疗效为 iPR
                 result = TargetAssessment.iPR;
@@ -1982,11 +1995,11 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
         /// {
         ///    疗效为 iCPD
         /// }
-        /// else if (上一访视新靶病灶评估为“iCPD”&& 有"存在"状态的新靶病灶)
+        /// else if (上一访视新靶病灶评估为“iCPD”&& （当有“存在”状态的淋巴结新靶病灶||当有“存在”或“太小”状态的非淋巴结新靶病灶）)
         /// {
         ///     疗效为 iCPD
         /// }
-        /// else if (有存在状态的新靶病灶时评估为该结果)
+        ///  else if (当有“存在”状态的淋巴结新靶病灶||当有“存在”或“太小”状态的非淋巴结新靶病灶)
         /// {
         ///     疗效为 iUPD
         /// }
@@ -2029,15 +2042,41 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                 // 至少有一个新靶病无法评估
                 ExixtsUnevaluableState = tableQuestion.SelectMany(x => x.TableQuestionList).Any(x => x.QuestionMark == QuestionMark.State && x.Answer.EqEnum(NewTargetLesionState.NotEvaluable)),
 
+
+                // 当有“存在”状态的淋巴结新靶病灶
+                ExixtsLymphTarget = false,
+
+                // 当有“存在”或“太小”状态的非淋巴结新靶病灶
+                ExixtsOrLessNoLymphTarget = false,
             };
 
 
             foreach (var item in tableQuestion)
             {
                 data.AllVanish = data.AllVanish && item.TableQuestionList.Any(x => x.QuestionMark == QuestionMark.State && x.Answer.EqEnum(NewTargetLesionState.Loss));
+
+
+                data.ExixtsLymphTarget = data.ExixtsLymphTarget || 
+                    (
+                    item.TableQuestionList.Any(x => x.QuestionMark == QuestionMark.State && x.Answer.EqEnum(NewTargetLesionState.Exist)) &&
+                item.TableQuestionList.Any(x => x.QuestionMark == QuestionMark.IsLymph && x.Answer.EqEnum(YesOrNoOrNa.Yes))
+                );
+
+                data.ExixtsOrLessNoLymphTarget = data.ExixtsLymphTarget || 
+                    (
+                    
+                    (
+                    item.TableQuestionList.Any(x => x.QuestionMark == QuestionMark.State && x.Answer.EqEnum(NewTargetLesionState.Exist)) 
+                    || item.TableQuestionList.Any(x => x.QuestionMark == QuestionMark.State && x.Answer.EqEnum(NewTargetLesionState.TooSmall))
+                    )
+                    
+                    &&
+              item.TableQuestionList.Any(x => x.QuestionMark == QuestionMark.IsLymph && !x.Answer.EqEnum(YesOrNoOrNa.Yes))
+              );
+
             }
 
-            NewTargetLesionAssessment result = NewTargetLesionAssessment.ND;
+            NewTargetLesionAssessment? result = null;
 
             // if（所有新靶病灶消失或一直不存在任何新靶病灶） 
             if(data.NotExistsNewTargetLesion||data.AllVanish)
@@ -2051,14 +2090,14 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                 //    疗效为 iCPD
                 result = NewTargetLesionAssessment.iCPD;
             }
-            // else if (上一访视新靶病灶评估为“iCPD”&& 有"存在"状态的新靶病灶)
-            else if (data.LastTaskNewTargetLesion.EqEnum(NewTargetLesionAssessment.iCPD) && data.HaveExixtsState)
+            // else if (上一访视新靶病灶评估为“iCPD”&& （当有“存在”状态的淋巴结新靶病灶||当有“存在”或“太小”状态的非淋巴结新靶病灶）)
+            else if (data.LastTaskNewTargetLesion.EqEnum(NewTargetLesionAssessment.iCPD) && data.ExixtsLymphTarget && data.ExixtsOrLessNoLymphTarget)
              {
                 //     疗效为 iCPD
                 result = NewTargetLesionAssessment.iCPD;
             }
-            // else if (有存在状态的新靶病灶时评估为该结果)
-            else if ( data.HaveExixtsState)
+            // else if (当有“存在”状态的淋巴结新靶病灶||当有“存在”或“太小”状态的非淋巴结新靶病灶)
+            else if ( data.HaveExixtsState||data.ExixtsOrLessNoLymphTarget)
              {
                 //     疗效为 iUPD
                 result = NewTargetLesionAssessment.iUPD;
@@ -2070,7 +2109,7 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                 result = NewTargetLesionAssessment.NE;
             }
 
-            return result.GetEnumInt();
+            return result==null?string.Empty: result.Value.GetEnumInt();
         }
         #endregion
 
diff --git a/IRaCIS.Core.Domain.Share/Reading/ReadEnum.cs b/IRaCIS.Core.Domain.Share/Reading/ReadEnum.cs
index e17780ed5..43c3fc008 100644
--- a/IRaCIS.Core.Domain.Share/Reading/ReadEnum.cs
+++ b/IRaCIS.Core.Domain.Share/Reading/ReadEnum.cs
@@ -1246,6 +1246,11 @@ namespace IRaCIS.Core.Domain.Share
         /// 无法评估
         /// </summary>
         NotEvaluable=3,
+
+        /// <summary>
+        /// 太小
+        /// </summary>
+        TooSmall=4,
     }
 
     /// <summary>
@@ -1469,9 +1474,9 @@ namespace IRaCIS.Core.Domain.Share
         ISOD = 24,
 
         /// <summary>
-        /// 与前一访视相比iSOD变化量
+        /// 与触发iRECIST访视相比iSOD变化量  Compared with triggering iRECIST visit
         /// </summary>
-        LastVisitiSODChange = 25,
+        ComparedTriggeringiSODChange = 25,
 
         /// <summary>
         /// 新靶病灶评估