Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
Department of Radiology, Naval Pohang Hospital, Pohang, Korea.
AJR Am J Roentgenol. 2019 Nov;213(5):1059-1072. doi: 10.2214/AJR.19.21485. Epub 2019 Aug 15.
The purpose of this study was to perform a systematic review and meta-analysis regarding CT features of non-small cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK) rearrangement. The PubMed and Embase databases were searched up to February 20, 2019. Studies that evaluated CT features of NSCLC with and without ALK rearrangement was included. Methodologic quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The association between CT features and ALK rearrangement was pooled in the form of the odds ratio (OR) or the mean difference (MD) using the random-effects model. Heterogeneity was examined using the inconsistency index (). Publication bias was examined using funnel plots and Egger tests. Sixteen studies were included, consisting of 3113 patients with NSCLC. The overall prevalence of patients with ALK rearrangement was 17% (528/3113). Compared with NSCLC without ALK rearrangement, on CT images those with ALK rearrangement were more frequently solid (OR = 2.86), central in location (OR = 2.72), and 3 cm or smaller (OR = 0.57); had lower contrast-enhanced CT attenuation (MD = -4.79 HU); more frequently had N2 or N3 disease (OR = 5.63), lymphangitic carcinomatosis (OR = 3.46), pleural effusion (OR = 1.91), or pleural metastasis (OR = 1.81); and less frequently had lung metastasis (OR = 0.66). Heterogeneity varied among CT features ( = 0-80%). No significant publication bias was seen ( = 0.15). NSCLC with ALK rearrangement had several distinctive CT features compared with that without ALK rearrangement. These CT biomarkers may help identify patients likely to have ALK rearrangement.
本研究旨在对间变性淋巴瘤激酶（ALK）重排的非小细胞肺癌（NSCLC）的 CT 特征进行系统评价和荟萃分析。检索了 PubMed 和 Embase 数据库，截至 2019 年 2 月 20 日。纳入了评估 NSCLC 有无 ALK 重排的 CT 特征的研究。使用诊断准确性研究质量评估工具-2 评估方法学质量。使用随机效应模型，以比值比（OR）或均数差值（MD）的形式汇总 CT 特征与 ALK 重排之间的关联。使用不一致指数（）检查异质性。使用漏斗图和 Egger 检验检查发表偏倚。纳入了 16 项研究，共 3113 例 NSCLC 患者。ALK 重排患者的总体患病率为 17%（528/3113）。与无 ALK 重排的 NSCLC 相比，ALK 重排患者 CT 图像上更常为实性（OR=2.86）、中央型（OR=2.72）且直径为 3cm 或更小（OR=0.57）；增强 CT 衰减值较低（MD=-4.79HU）；更常出现 N2 或 N3 疾病（OR=5.63）、淋巴管癌病（OR=3.46）、胸腔积液（OR=1.91）或胸膜转移（OR=1.81）；而肺转移较少见（OR=0.66）。CT 特征的异质性不同（=0-80%）。未发现显著的发表偏倚（=0.15）。与无 ALK 重排的 NSCLC 相比，ALK 重排的 NSCLC 具有一些独特的 CT 特征。这些 CT 生物标志物可能有助于识别可能具有 ALK 重排的患者。
