1 Nuclear Medicine Department, PET Unit, Santa Maria della Misericordia Hospital, Viale Tre Martiri, 140, 45100 Rovigo, Italy.
AJR Am J Roentgenol. 2015 Jun;204(6):1261-8. doi: 10.2214/AJR.14.13210.
The purpose of this study was to assess the predictive value of (18)F-FDG PET/ CT for pathologic response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer.
A systematic search was performed (PubMed and Cochrane databases) for potentially relevant studies up to January 2014. Pooled sensitivity and specificity were calculated. The AUCs of the global cohort and for "major response," "complete response," "only PET after chemoradiotherapy," "ad interim PET," "major response excluding ad interim studies," "complete response excluding ad interim studies," "response index (RI)," "posttreatment maximum standardized uptake value (SUV(max) post)," "visual response analysis (VRA)," "percentage reduction of the total lesion glycolysis (ΔTLG)," and "percentage reduction of the metabolic tumor volume (ΔMTV)" were analyzed. Heterogeneity was explored for multiple variables. Pooled prevalence and 95% CI were calculated.
Thirty-four of 131 (26%) initial articles met the inclusion criteria. Those articles included 1526 patients. PET/CT showed good pooled accuracy both in the global cohort (pooled sensitivity, 73%; pooled specificity, 77%; pooled AUC, 0.83) and for subgroups. Pooled accuracy was similar for early PET restaging and at 1 and 2 weeks after beginning chemoradiotherapy (pooled sensitivity, 84%; pooled specificity, 81%; pooled AUC, 0.89). The major response group showed similar sensitivity to the complete response group (74% and 71%, respectively). RI, SUV(max), and VRA were the most frequent parameters used. Pooled RI and SUV(max) postcutoff values were 63% and 4.4. Pooled time to PET during and after chemoradiotherapy was 1.5 and 6.5 weeks, respectively.
This meta-analysis supports the use of FDG PET for restaging locally advanced rectal cancer.
本研究旨在评估 18F-FDG PET/CT 对局部晚期直肠癌新辅助放化疗病理反应的预测价值。
系统检索（PubMed 和 Cochrane 数据库）截至 2014 年 1 月的潜在相关研究。计算汇总敏感性和特异性。分析全球队列和“主要反应”、“完全反应”、“仅放化疗后 PET”、“中期 PET”、“排除中期研究的主要反应”、“排除中期研究的完全反应”、“反应指数（RI）”、“治疗后最大标准化摄取值（SUV(max) post）”、“视觉反应分析（VRA）”、“总肿瘤糖酵解降低百分比（ΔTLG）”和“代谢肿瘤体积降低百分比（ΔMTV）”的 AUC。针对多个变量进行了异质性探讨。计算了汇总患病率和 95%CI。
34 篇初始文章中的 131 篇（26%）符合纳入标准。这些文章包括 1526 名患者。PET/CT 在全球队列（汇总敏感性 73%，汇总特异性 77%，汇总 AUC 0.83）和亚组中均显示出良好的汇总准确性。早期 PET 重新分期以及放化疗开始后 1 周和 2 周的汇总准确性相似（汇总敏感性 84%，汇总特异性 81%，汇总 AUC 0.89）。主要反应组与完全反应组的敏感性相似（分别为 74%和 71%）。RI、SUV(max)和 VRA 是最常用的参数。汇总 RI 和 SUV(max) cutoff 值分别为 63%和 4.4。放化疗期间和之后进行 PET 的汇总时间分别为 1.5 周和 6.5 周。
本荟萃分析支持使用 FDG PET 对局部晚期直肠癌进行重新分期。
