Authors' Affiliations: Center for Evaluation Value and Risk in Health, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Departments of Imaging and Medical Oncology, Dana-Farber Cancer Institute; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Clin Cancer Res. 2013 Dec 1;19(23):6566-77. doi: 10.1158/1078-0432.CCR-13-1511. Epub 2013 Sep 19.
Use of 2[(18)F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in postchemotherapy response assessment in follicular lymphoma is still a controversial issue. Here, we conducted the first systematic review and meta-analysis to determine the predictive value of FDG-PET in predicting outcome after chemotherapy of follicular lymphoma.
Comprehensive literature search in Ovid-MEDLINE and EMBASE databases was performed to identify studies which evaluate predictive value of end-therapy PET and/or computed tomography (CT) in patients with follicular lymphoma. To quantitatively compare the predictive value of PET and CT, pooled hazard ratios (HRs) comparing progression-free survival (PFS) between patients with positive and negative results were adopted as the primary indicators for meta-analysis. To explore the efficiency in determining complete remission (CR), pooled CR rates of PET- and CT-based response criteria were calculated. Pooling of these parameters was based on the random-effects model.
Review of 285 candidate articles identified eight eligible articles with a total of 577 patients for qualitative review and meta-analysis. The pooled HRs of end-therapy PET and CT were 5.1 [95% confidence interval (CI), 3.7-7.2] and 2.6 (95% CI, 1.2-5.8), respectively, which implies that PET is more predictive of PFS after chemotherapy than CT. The pooled CR rates of PET- and CT-based response criteria were 75% (95% CI, 70-79%) and 63% (95% CI, 53-73%), respectively, which implies that PET is more efficient in distinguishing CR (without residual disease) from other states with residual disease. In addition, qualitative systematic review indicates the same findings.
Consistent evidence favoring PET-based treatment assessment should be considered in the management of patients with follicular lymphoma.
使用 2[(18)F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）在滤泡性淋巴瘤的化疗后反应评估中仍然是一个有争议的问题。在这里，我们进行了首次系统评价和荟萃分析，以确定 FDG-PET 在预测滤泡性淋巴瘤化疗后的预后中的预测价值。
在 Ovid-MEDLINE 和 EMBASE 数据库中进行全面的文献检索，以确定评估滤泡性淋巴瘤患者治疗后 PET 和/或计算机断层扫描（CT）预测价值的研究。为了定量比较 PET 和 CT 的预测价值，采用比较阳性和阴性结果患者无进展生存期（PFS）的合并危险比（HR）作为荟萃分析的主要指标。为了探索确定完全缓解（CR）的效率，计算了基于 PET 和 CT 的反应标准的合并 CR 率。这些参数的汇总基于随机效应模型。
对 285 篇候选文章进行审查，确定了 8 篇合格的文章，共 577 例患者进行定性综述和荟萃分析。治疗后 PET 和 CT 的合并 HR 分别为 5.1[95%置信区间（CI），3.7-7.2]和 2.6（95%CI，1.2-5.8），这意味着 PET 比 CT 更能预测化疗后的 PFS。基于 PET 和 CT 的反应标准的合并 CR 率分别为 75%（95%CI，70-79%）和 63%（95%CI，53-73%），这意味着 PET 在区分无残留疾病的 CR（完全缓解）和其他残留疾病状态方面更有效。此外，定性系统评价也得出了相同的结论。
在滤泡性淋巴瘤患者的管理中，应考虑支持基于 PET 的治疗评估的一致证据。
