Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Int J Cancer. 2012 Dec 1;131(11):2604-11. doi: 10.1002/ijc.27557. Epub 2012 Jun 28.
The purpose of this meta-analysis was to evaluate the utility of positron emission tomography (PET) using fluor-18-deoxyglucose (FDG) to predict the response of rectal cancer to neo-adjuvant therapy. All previously published studies on the role of FDG-PET in predicting the response of rectal cancer to neo-adjuvant therapy were collected. Pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using statistical software. A total of 28 studies, comprising 1,204 patients with rectal cancer, were included in the meta-analysis. Pooled sensitivity, specificity, PPV and NPV for FDG-PET predicting the response to therapy was 78% [95% confidence interval (CI): 75-82%], 66% (95% CI: 62-69%), 70% (95% CI; 66-73%) and 75% (95% CI: 71-0.79%), respectively. The included studies were of a relatively high methodological quality according to the QUADAS (quality assessment of studies of diagnostic accuracy included in systematic reviews) criteria. Based on the subgroup analyses, there was no significant difference between the response index, the standardized uptake value and the visual response score in predicting the therapy response. However, the accuracy of the group that underwent PET scanning during therapy showed significantly higher values (sensitivity 86% and specificity 80%) than the group that was scanned after completion of the therapy. Therefore, FDG-PET is valuable for predicting the response of rectal carcinoma to neo-adjuvant therapy, and early evaluation of response during the therapy may be more promising. However, additional studies using prospective clinical trials will be required to assess the clinical benefit of this strategy.
本次荟萃分析的目的在于评估氟-18-脱氧葡萄糖（FDG）正电子发射断层扫描（PET）在预测直肠癌对新辅助治疗的反应中的作用。收集了所有关于 FDG-PET 在预测直肠癌对新辅助治疗反应中的作用的已发表研究。使用统计软件计算了汇总敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。荟萃分析共纳入 28 项研究，包括 1204 例直肠癌患者。FDG-PET 预测治疗反应的汇总敏感性、特异性、PPV 和 NPV 分别为 78%（95%CI：75-82%）、66%（95%CI：62-69%）、70%（95%CI：66-73%）和 75%（95%CI：71-0.79%）。根据 QUADAS（纳入系统评价的诊断准确性研究质量评估）标准，纳入的研究具有较高的方法学质量。根据亚组分析，在预测治疗反应方面，反应指数、标准化摄取值和视觉反应评分之间没有显著差异。然而，在治疗过程中进行 PET 扫描的组的准确性显示出显著更高的值（敏感性 86%和特异性 80%），高于治疗完成后进行扫描的组。因此，FDG-PET 对预测直肠癌对新辅助治疗的反应具有价值，在治疗过程中对反应进行早期评估可能更有前途。然而，需要使用前瞻性临床试验来评估该策略的临床获益。
