Suh C H, Shinagare A B, Westenfield A M, Ramaiya N H, Van den Abbeele A D, Kim K W
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea; Department of Radiology, Namwon Medical Center, 365, Chungjeong-Ro, Namwon-Si, Jeollabuk-Do 590-702, Republic of Korea.
Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Clin Radiol. 2018 Feb;73(2):158-167. doi: 10.1016/j.crad.2017.08.004. Epub 2017 Sep 25.
To evaluate the yield of staging bone scintigraphy in patients with treatment-naive prostate cancer.
A computerised search of the MEDLINE and EMBASE databases was performed to find relevant original literature. Studies that investigated the positivity of a staging bone scintigraphy according to prostate-specific antigen (PSA) levels and/or Gleason score in patients with treatment-naive prostate cancer were eligible for inclusion. Meta-analytic pooling was performed using the inverse variance method for calculating weights.
Fifty-four eligible studies, which included a total sample size of 20,421 patients, were included. The pooled proportions of the positive bone scintigraphy in patients with PSA ≤10, 10 <PSA ≤20, and PSA >20 were 3.5% (95% confidence interval [CI]: 2.4-5%), 6.9% (95% CI: 4.5-10.3%), and 41.8% (95% CI: 36.3-47.6%). The pooled proportions of the positive bone scintigraphy examinations in patients with Gleason score ≤6, 7, and ≥8 were 4.1% (95% CI: 2-8%), 10% (95% CI: 6.1-15.8%), and 28.7% (95% CI: 21.8-36.8%). Meta-regression analysis revealed that the Gleason score was a significant factor affecting study heterogeneity in patients with PSA ≤10 (p = 0.04). Pooled proportions of positive bone scintigraphy examinations showed 3.4% in patients with a PSA of ≤10 and 3.3% in patients with 10 <PSA ≤20 regarding a Gleason score of ≤7.
The present results demonstrate a low proportion of positive bone scintigraphy examinations in treatment-naïve prostate cancer patients with PSA≤20 and Gleason score ≤7. The present study may help guide decision support in daily clinical practice regarding the need for bone scintigraphy in this group of patients and might be considered in the design of future clinical guidelines.
评估初治前列腺癌患者分期骨闪烁显像的检出率。
对MEDLINE和EMBASE数据库进行计算机检索，以查找相关的原始文献。纳入研究初治前列腺癌患者根据前列腺特异性抗原（PSA）水平和/或 Gleason评分进行分期骨闪烁显像阳性情况的研究。采用逆方差法进行荟萃分析合并以计算权重。
纳入54项符合条件的研究，总样本量为20421例患者。PSA≤10、10＜PSA≤20和PSA＞20患者骨闪烁显像阳性的合并比例分别为3.5%（95%置信区间[CI]：2.4 - 5%）、6.9%（95%CI：4.5 - 10.3%）和41.8%（95%CI：36.3 - 47.6%）。Gleason评分≤6、7和≥8患者骨闪烁显像检查阳性的合并比例分别为4.1%（95%CI：2 - 8%）、10%（95%CI：6.1 - 15.8%）和28.7%（95%CI：21.8 - 36.8%）。荟萃回归分析显示，Gleason评分是影响PSA≤10患者研究异质性的显著因素（p = 0.04）。对于Gleason评分≤7的患者，PSA≤10患者骨闪烁显像检查阳性的合并比例为3.4%，10＜PSA≤20患者为3.3%。
目前结果表明，PSA≤20且Gleason评分≤7的初治前列腺癌患者骨闪烁显像检查阳性比例较低。本研究可能有助于指导日常临床实践中关于该组患者是否需要进行骨闪烁显像的决策支持，并可能在未来临床指南的制定中予以考虑。
