Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Crit Rev Oncol Hematol. 2016 Oct;106:55-63. doi: 10.1016/j.critrevonc.2016.07.003. Epub 2016 Jul 16.
This study aimed to systematically review and meta-analyze the prognostic value of interim (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). MEDLINE and EMBASE were systematically searched for suitable studies. Included studies were methodologically appraised, and results were summarized both descriptively and meta-analytically. Nine studies, comprising a total of 996 R-CHOP-treated DLBCL patients, were included. Overall, studies were of moderate methodological quality. The area under the summary receiver operating curve (AUC) of interim FDG-PET in predicting treatment failure and death were 0.651 and 0.817, respectively. There was no heterogeneity in diagnostic odds ratios across available studies (I(2)=0.0%). At multivariable analysis, 2 studies reported interim FDG-PET to have independent prognostic value in addition to the International Prognostic Index (IPI) in predicting treatment failure, whereas 3 studies reported that this was not the case. One study reported interim FDG-PET to have independent prognostic value in addition to the IPI in predicting death, whereas 2 studies reported that this was not the case. In conclusion, interim FDG-PET in R-CHOP-treated DLBCL has some correlation with outcome, but its prognostic value is homogeneously suboptimal across studies and it has not consistently proven to surpass the prognostic potential of the IPI. Moreover, there is a lack of studies that compared interim FDG-PET to the recently developed and superior National Comprehensive Cancer Network-IPI. Therefore, at present there is no scientific base to support the clinical use of interim FDG-PET in R-CHOP-treated DLBCL.
本研究旨在系统回顾和荟萃分析利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）治疗弥漫性大 B 细胞淋巴瘤（DLBCL）患者中中期（18）F-氟代-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）的预后价值。系统检索 MEDLINE 和 EMBASE 以获取合适的研究。对纳入的研究进行方法学评估，并分别进行描述性和荟萃分析总结结果。纳入了 9 项研究，共包括 996 例接受 R-CHOP 治疗的 DLBCL 患者。总体而言，这些研究的方法学质量中等。中期 FDG-PET 预测治疗失败和死亡的汇总受试者工作特征曲线下面积（AUC）分别为 0.651 和 0.817。在可用的研究中，诊断比值比的异质性为零（I(2)=0.0%）。多变量分析显示，有 2 项研究报告中期 FDG-PET 除国际预后指数（IPI）外，对预测治疗失败具有独立的预后价值，而有 3 项研究则不然。有 1 项研究报告中期 FDG-PET 除 IPI 外，对预测死亡具有独立的预后价值，而有 2 项研究则不然。总之，R-CHOP 治疗的 DLBCL 中中期 FDG-PET 与结局有一定的相关性，但在各研究中其预后价值均不理想，且尚未一致证明优于 IPI 的预后潜力。此外，缺乏将中期 FDG-PET 与最近开发的、更优的美国国家综合癌症网络-IPI 进行比较的研究。因此，目前尚无科学依据支持在 R-CHOP 治疗的 DLBCL 中使用中期 FDG-PET。
