Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy.
Clin Nucl Med. 2013 May;38(5):305-14. doi: 10.1097/RLU.0b013e3182867f3c.
The increase of prostate-specific antigen (PSA) after radical retropubic prostatectomy (RP) or external beam radiotherapy (EBRT) is the most sensitive tool for detecting prostate cancer (PCa) recurrence, although this measure cannot distinguish between local, regional, or distant recurrence. The aim of this meta-analysis was to evaluate the diagnostic performance of 18F-choline and 11C-choline PET or PET/CT in detection of locoregional or distant metastases in PCa.
Medline, Web of Knowledge, and Google Scholar search was carried out in order to select English-language articles dealing with diagnostic performance of both 18F-choline and 11C-choline PET for the detection of PCa recurrence after RP or EBRT. Articles were included only if absolute numbers of true-positive, true-negative, false-positive, and false-negative test results were available or derivable from the text and regarded local, lymph node, and distant metastases. Reviews, clinical reports, and editorial articles were excluded. All complete studies were re-analyzed thus performing a quantitative analysis.
From the years 2000 to 2012, we found 53 complete articles that critically evaluated the role of choline PET in restaging patients with PCa recurrence. The meta-analysis was carried out and dealt with 19 selected studies (12 studies for all sites of disease, 3 for lymph node metastases, and 4 for local recurrence), with a total of 1555 patients. The meta-analysis provided a pooled sensitivity of 85.6% (95% CI: 82.9%-88.1%) and pooled specificity of 92.6% (95% CI: 90.1%-94.6%) for all sites of disease (prostatic fossa, lymph nodes, and bone), a pooled sensitivity of 75.4% (95% CI: 66.9%-82.6%) and pooled specificity of 82% (95% CI: 68.6%-91.4%) for prostatic fossa recurrence, and a pooled sensitivity of 100% (95% CI: 90.5%-100%) and pooled specificity of 81.8% (95% CI: 48.2%-97.7%) for lymph node metastases. The heterogeneity ranged between 0.00% and 88.6%. The diagnostic odds ratios were 62.123 (95% CI: 24.783-155.72), 5.869 (95% CI: 1.818-18.946), and 138.57 (95% CI: 11.27-1703.8), respectively, for all sites of disease, local recurrence, and lymph node disease.
Choline PET and PET/CT represent high sensitivity and specificity techniques for the detection of locoregional and distant metastases in PCa patients with recurrence of disease. Moreover, a high diagnostic odds ratio was found for the identification of lymph node disease in patients with biochemical recurrence of PCa.
根治性前列腺切除术（RP）或外照射放疗（EBRT）后前列腺特异性抗原（PSA）的升高是检测前列腺癌（PCa）复发最敏感的工具，尽管这种方法无法区分局部、区域或远处复发。本荟萃分析的目的是评估 18F-胆碱和 11C-胆碱 PET 或 PET/CT 在检测 RP 或 EBRT 后 PCa 局部或远处转移中的诊断性能。
为了选择涉及 RP 或 EBRT 后检测 PCa 复发的 18F-胆碱和 11C-胆碱 PET 诊断性能的英文文章，我们在 Medline、Web of Knowledge 和 Google Scholar 上进行了搜索。只有当可以获得或从文本中推导出真阳性、真阴性、假阳性和假阴性测试结果时，文章才会被包括在内，并被认为是局部、淋巴结和远处转移。综述、临床报告和社论文章被排除在外。所有完整的研究都重新进行了分析，从而进行了定量分析。
从 2000 年到 2012 年，我们发现了 53 篇批判性评估胆碱 PET 在 PCa 复发患者再分期中作用的完整文章。进行了荟萃分析，并处理了 19 项选定的研究（12 项研究涉及所有疾病部位，3 项研究涉及淋巴结转移，4 项研究涉及局部复发），共有 1555 名患者。荟萃分析提供了所有疾病部位（前列腺窝、淋巴结和骨骼）的汇总敏感性为 85.6%（95%CI：82.9%-88.1%）和汇总特异性为 92.6%（95%CI：90.1%-94.6%），前列腺窝复发的汇总敏感性为 75.4%（95%CI：66.9%-82.6%）和汇总特异性为 82%（95%CI：68.6%-91.4%），淋巴结转移的汇总敏感性为 100%（95%CI：90.5%-100%）和汇总特异性为 81.8%（95%CI：48.2%-97.7%）。异质性范围在 0.00%至 88.6%之间。诊断比值比分别为 62.123（95%CI：24.783-155.72）、5.869（95%CI：1.818-18.946）和 138.57（95%CI：11.27-1703.8），分别用于所有疾病部位、局部复发和淋巴结疾病。
胆碱 PET 和 PET/CT 是检测 PCa 患者疾病复发时局部和远处转移的高灵敏度和特异性技术。此外，对于检测 PCa 生化复发患者的淋巴结疾病，发现了高诊断比值比。
