18F-FDG PET 和 PET/CT 对评估乳腺癌新辅助化疗治疗反应的预后价值：系统评价和荟萃分析。

Prognostic value of F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis.

机构信息

Department of Nuclear Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.

Department of Nuclear Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.

出版信息

Breast Cancer Res. 2020 Oct 31;22(1):119. doi: 10.1186/s13058-020-01350-2.

BACKGROUND

We performed a systematic review and meta-analysis to evaluate the prognostic significance of F-FDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients.

METHODS

We searched PubMed, Embase, and the Cochrane Library databases until June 2020 to identify studies that assessed the prognostic value of F-FDG PET scans during or after NAC with regard to overall (OS) and disease-free survival (DFS). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled meta-analytically using a random-effects model.

RESULTS

Twenty-one studies consisting of 1630 patients were included in the qualitative synthesis. Twelve studies investigated the use of PET scans for interim response evaluation (during NAC) and 10 studies assessed post-treatment PET evaluation (after NAC). The most widely evaluated parameter distinguishing metabolic responders from poor responders on interim or post-treatment PET scans was %ΔSUVmax, defined as the percent reduction of SUVmax compared to baseline PET, followed by SUVmax and complete metabolic response (CMR). For the 17 studies included in the meta-analysis, the pooled HR of metabolic responses on DFS was 0.21 (95% confidence interval [CI], 0.14-0.32) for interim PET scans and 0.31 (95% CI, 0.21-0.46) for post-treatment PET scans. Regarding the influence of metabolic responses on OS, the pooled HRs for interim and post-treatment PET scans were 0.20 (95% CI, 0.09-0.44) and 0.26 (95% CI, 0.14-0.51), respectively.

CONCLUSIONS

The currently available literature suggests that the use of F-FDG PET or PET/CT for evaluation of response to NAC provides significant predictive value for disease recurrence and survival in breast cancer patients and might allow risk stratification and guide rational management.

背景

我们进行了一项系统评价和荟萃分析，以评估 F-FDG PET 和 PET/CT 对乳腺癌患者新辅助化疗（NAC）反应评估的预后意义。

方法

我们检索了 PubMed、Embase 和 Cochrane 图书馆数据库，截至 2020 年 6 月，以确定评估 F-FDG PET 扫描在 NAC 期间或之后评估总生存期（OS）和无病生存期（DFS）的预后价值的研究。使用随机效应模型进行荟萃分析，合并危险比（HR）及其 95%置信区间（CI）。

结果

21 项研究共纳入 1630 例患者，进行了定性综合分析。12 项研究调查了 PET 扫描在中期反应评估（NAC 期间）中的应用，10 项研究评估了治疗后 PET 评估（NAC 后）。在中期或治疗后 PET 扫描中，区分代谢反应者和不良反应者的最广泛评估参数是%ΔSUVmax，定义为与基线 PET 相比 SUVmax 的百分比降低，其次是 SUVmax 和完全代谢反应（CMR）。对于纳入荟萃分析的 17 项研究，代谢反应对 DFS 的合并 HR 为中期 PET 扫描时为 0.21（95%置信区间 [CI]，0.14-0.32），治疗后 PET 扫描时为 0.31（95%CI，0.21-0.46）。关于代谢反应对 OS 的影响，中期和治疗后 PET 扫描的合并 HR 分别为 0.20（95%CI，0.09-0.44）和 0.26（95%CI，0.14-0.51）。