Fu Zhan-Zhao, Peng Yong, Cao Li-Yan, Chen Yan-Sheng, Li Kun, Fu Bao-Hong
Department of Oncology, the First Hospital of Qinhuangdao, Qinhuangdao 066000, P.R. China.
Department of Bioengineering, Yanshan University, Qinhuangdao 066000, P.R. China.
Magn Reson Imaging. 2015 Jun;33(5):516-24. doi: 10.1016/j.mri.2015.02.002. Epub 2015 Feb 7.
We investigated the clinical significance of apparent diffusion coefficient (ADC) values in diffusion-weighted magnetic resonance imaging (DWI) in monitoring the efficacy of radiotherapy (RT) and chemotherapy (CT) treatments in cervical cancer.
In order to identify relevant high quality clinical cohort studies reporting the use of DWI in cervical cancers, the following electronic databases in English and Chinese languages were comprehensively searched: MEDLINE, Science Citation Index database, Cochrane Library Database, PubMed, Embase, CINAHL, and Current Contents Index; Chinese Biomedical Database, Chinese Journal Full-Text Database. All selected studies were published prior to March 2014, and data extracted from these studies were analyzed using STATA 12.0 statistical software.
We initially retrieved 196 articles (79 Chinese articles and 117 English articles) through database searches and finally selected sixteen cohort studies for this meta-analysis. The 16 studies contained a combined total of 517 subjects, and all selected studies reported the mean ADC value (10(-3) mm(2)/s) in DWI in cervical cancer patients treated with RT and CT. Combined standardized mean difference (SMD) suggested that the mean post-RT and mean post-CT ADC values were significantly higher than the mean pre-RT and mean pre-CT ADC values, respectively, in cervical cancer patients (SMD=2.95, 95% CI=2.19-3.72, P<0.001). Ethnicity-stratified analysis revealed that increased ADC values were observed post-RT and post-CT in both Caucasian (SMD=1.44, 95% CI=0.93-1.95, P<0.001) and Asian populations (SMD=3.32, 95% CI=2.42-4.22, P<0.001), compared with the mean ADC values before RT and CT, respectively, in the two subgroups. Further, subgroup analysis based on b-value revealed that higher ADC values were found in cervical cancer patients after RT and CT, compared to before RT and CT treatment, with both b value≤900 (SMD=3.71, 95% CI=2.35-5.07, P<0.001) and >900 (SMD=2.55, 95% CI=1.78-3.32, P<0.001). The mean ADC value in patients without residual tumor post-RT and post-CT treatment was significantly higher than seen in patients with residual tumors (SMD=0.80, 95% CI=0.49-1.12, P<0.001).
Our meta-analysis revealed a significant correlation between mean ADC values and the clinical response to RT and CT treatment. Thus, ADC values in DWI may be effective in evaluating the clinical outcome of treatments in cervical cancer patients.
我们研究了扩散加权磁共振成像（DWI）中的表观扩散系数（ADC）值在监测宫颈癌放疗（RT）和化疗（CT）疗效方面的临床意义。
为了识别报告在宫颈癌中使用DWI的相关高质量临床队列研究，全面检索了以下英文和中文电子数据库：MEDLINE、科学引文索引数据库、Cochrane图书馆数据库、PubMed、Embase、CINAHL和现刊目次索引；中国生物医学数据库、中国期刊全文数据库。所有入选研究均在2014年3月之前发表，从这些研究中提取的数据使用STATA 12.0统计软件进行分析。
我们最初通过数据库检索获得196篇文章（79篇中文文章和117篇英文文章），最终选择了16项队列研究进行该荟萃分析。这16项研究共纳入517名受试者，所有入选研究均报告了接受RT和CT治疗的宫颈癌患者DWI中的平均ADC值（10⁻³ mm²/s）。合并标准化均值差（SMD）表明，宫颈癌患者放疗后和化疗后的平均ADC值分别显著高于放疗前和化疗前的平均ADC值（SMD = 2.95，95% CI = 2.19 - 3.72，P < 0.001）。按种族分层分析显示，与放疗和化疗前的平均ADC值相比，白种人（SMD = 1.44，95% CI = 0.93 - 1.95，P < 0.001）和亚洲人群（SMD = 3.32，95% CI = 2.42 - 4.22，P < 0.001）放疗后和化疗后的ADC值均升高。此外，基于b值的亚组分析显示，与放疗和化疗前相比，b值≤900（SMD = 3.71，95% CI = 2.35 - 5.07，P < 0.001）和>900（SMD = 2.55，95% CI = 1.78 - 3.32，P < 0.001）的宫颈癌患者放疗和化疗后的ADC值均更高。放疗和化疗后无残留肿瘤患者的平均ADC值显著高于有残留肿瘤患者（SMD = 0.80，95% CI = 0.49 - 1.12，P < 0.001）。
我们的荟萃分析显示平均ADC值与RT和CT治疗的临床反应之间存在显著相关性。因此，DWI中的ADC值可能有助于评估宫颈癌患者的治疗临床结局。
