18F FDG PET 预测食管癌新辅助治疗的肿瘤反应：系统评价。
Prediction of tumor response to neoadjuvant therapy in patients with esophageal cancer with use of 18F FDG PET: a systematic review.
机构信息
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
出版信息
Radiology. 2010 Mar;254(3):707-17. doi: 10.1148/radiol.09091324.
PURPOSE
To systematically review the accuracy of fluorine 18 ((18)F) fluorodeoxyglucose (FDG) positron emission tomography (PET) in the prediction of tumor response to neoadjuvant therapy in patients with esophageal cancer.
MATERIALS AND METHODS
The MEDLINE and EMBASE databases were systematically searched for relevant studies. Methodologic quality of the included studies was assessed. Sensitivities and specificities of (18)F FDG PET in individual studies were calculated and underwent meta-analysis with a random effects model. A summary receiver operating characteristic curve (sROC) was constructed with the Moses-Shapiro-Littenberg method. A chi(2) test was performed to test for heterogeneity (defined as P < .10). Potential sources for heterogeneity were explored by assessing whether certain covariates significantly (P < .05) influenced the relative diagnostic odds ratio.
RESULTS
Twenty reports, comprising a total of 849 patients with esophageal cancer, were included. Overall, the studies were of moderate methodologic quality. Sensitivity and specificity of (18)F FDG PET ranged from 33% to 100% and from 30% to 100%, respectively, with pooled estimates of 67% (95% confidence interval: 62%, 72%) and 68% (95% confidence interval: 64%, 73%), respectively. The area under the sROC curve was 0.7815. There was significant heterogeneity in both the sensitivity and specificity of the included studies (P < .0001). Spearman rho between the logit of sensitivity and the logit of 1-specificity was 0.086 (P = .719), which suggested that there was no threshold effect. Studies performed outside of the United States and studies of higher methodologic quality yielded significantly higher overall accuracy.
CONCLUSION
On the basis of current evidence, (18)F FDG PET should not yet be used in routine clinical practice to guide neoadjuvant therapy decisions in patients with esophageal cancer.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091324/-/DC1.
目的
系统评价氟 18（18）F 氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）在预测食管癌患者新辅助治疗反应中的准确性。
材料与方法
系统检索 MEDLINE 和 EMBASE 数据库中相关研究。评估纳入研究的方法学质量。计算各研究中（18）F FDG PET 的敏感度和特异度，并采用随机效应模型进行荟萃分析。采用 Moses-Shapiro-Littenberg 法构建汇总受试者工作特征曲线（sROC）。采用卡方检验（P<.10）检测异质性。通过评估某些协变量是否显著（P<.05）影响相对诊断比值比，来探索异质性的潜在来源。
结果
共纳入 20 项研究，共计 849 例食管癌患者。总体而言，这些研究的方法学质量为中等。（18）F FDG PET 的敏感度和特异度范围分别为 33%100%和 30%100%，汇总估计值分别为 67%（95%置信区间：62%，72%）和 68%（95%置信区间：64%，73%）。sROC 曲线下面积为 0.7815。纳入研究的敏感度和特异度均存在显著异质性（P<.0001）。敏感度和 1-特异度的对数之间的 Spearman rho 为 0.086（P=.719），表明不存在阈值效应。在美国以外进行的研究和方法学质量较高的研究得出的总体准确性明显较高。
结论
根据目前的证据，（18）F FDG PET 不应用于常规临床实践来指导食管癌患者的新辅助治疗决策。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091324/-/DC1.
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