Kroese T E, Goense L, van Hillegersberg R, de Keizer B, Mook S, Ruurda J P, van Rossum P S N
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Dis Esophagus. 2018 Dec 1;31(12). doi: 10.1093/dote/doy055.
Restaging after neoadjuvant therapy aims to reduce the number of patients undergoing esophagectomy in case of distant (interval) metastases. The aim of this study is to systematically review and meta-analyze the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and 18F-FDG PET/CT for the detection of distant interval metastases after neoadjuvant therapy in patients with esophageal cancer. PubMed/MEDLINE, Embase, and the Cochrane library were systematically searched. The analysis included diagnostic studies reporting on the detection of distant interval metastases with 18F-FDG PET(/CT) in patients with esophageal cancer who received neoadjuvant therapy and both baseline staging and restaging after neoadjuvant therapy with 18F-FDG PET(/CT) imaging. The primary outcome measure was the proportion of patients in whom distant interval metastases were detected by 18F-FDG PET(/CT) as confirmed by pathology or clinical follow-up (i.e. true positives). The secondary outcome measure was the proportion of patients in whom 18F-FDG PET(/CT) restaging was false positive for distant interval metastases (i.e. false positives). Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Random-effect models were used to estimate pooled outcomes and examine potential sources of heterogeneity. Fourteen studies were included comprising a total of 1,110 patients who received baseline staging with 18F-FDG PET(/CT) imaging of whom 1,001 (90%) underwent restaging with 18F-FDG PET(/CT) imaging. Studies were generally of moderate quality. The pooled proportion of patients in whom true distant interval metastases were detected by 18F-FDG PET(/CT) restaging was 8% (95% confidence interval [CI]: 5-13%). The pooled proportion of patients in whom false positive distant findings were detected by 18F-FDG PET(/CT) restaging was 5% (95% CI: 3-9%). In conclusion,18F-FDG PET(/CT) restaging after neoadjuvant therapy for esophageal cancer detects true distant interval metastases in 8% of patients. Therefore, 18F-FDG PET(/CT) restaging can considerably impact on treatment decision-making. However, false positive distant findings occur in 5% of patients at restaging with 18F-FDG PET(/CT), underlining the need for pathological confirmation of suspected lesions.
新辅助治疗后的再分期旨在减少远处（间隔期）转移患者接受食管切除术的数量。本研究的目的是系统评价和荟萃分析18F-氟脱氧葡萄糖正电子发射断层扫描（18F-FDG PET）和18F-FDG PET/CT在检测食管癌患者新辅助治疗后远处间隔期转移方面的诊断性能。对PubMed/MEDLINE、Embase和Cochrane图书馆进行了系统检索。分析纳入了诊断研究，这些研究报告了在接受新辅助治疗的食管癌患者中，用18F-FDG PET（/CT）检测远处间隔期转移，以及用18F-FDG PET（/CT）成像进行新辅助治疗后的基线分期和再分期。主要结局指标是经病理或临床随访证实（即真阳性），通过18F-FDG PET（/CT）检测到远处间隔期转移的患者比例。次要结局指标是18F-FDG PET（/CT）再分期对远处间隔期转移为假阳性（即假阳性）的患者比例。使用QUADAS-2工具评估偏倚风险和适用性问题。采用随机效应模型估计汇总结局并检查潜在的异质性来源。纳入了14项研究，共1110例患者接受了18F-FDG PET（/CT）成像的基线分期，其中1001例（90%）接受了18F-FDG PET（/CT）成像的再分期。研究质量一般为中等。18F-FDG PET（/CT）再分期检测到真正远处间隔期转移的患者汇总比例为8%（95%置信区间[CI]：5-13%）。18F-FDG PET（/CT）再分期检测到假阳性远处结果的患者汇总比例为5%（95%CI：3-9%）。总之，食管癌新辅助治疗后的18F-FDG PET（/CT）再分期在8%的患者中检测到真正的远处间隔期转移。因此，18F-FDG PET（/CT）再分期可对治疗决策产生重大影响。然而，18F-FDG PET（/CT）再分期时5%的患者出现假阳性远处结果，这突出了对疑似病变进行病理确认的必要性。
