Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada.
Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada.
Eur J Nucl Med Mol Imaging. 2023 Dec;51(1):258-277. doi: 10.1007/s00259-023-06393-z. Epub 2023 Aug 18.
To provide comprehensive data on the diagnostic and prognostic value of [F]-FDG PET (PET) in anal canal cancer patients.
This study was designed following the PRISMA-DTA guidelines. For the meta-analysis, published original articles (until December 2022) that met the following criteria were included: Evaluated PET for locoregional and/or distant disease detection in patients with histopathology-proven anal canal cancer; Compared PET with a valid reference standard; Provided crude data to calculate meta-analytic estimates. Diagnostic measurements from subgroups were calculated in evaluating primary tumour detection, T stage, lymph node and distant metastases. Articles providing prognostic information on PET were also reported as a systematic review. For pooled meta-analytic calculations, the hierarchical method was used. The bivariate model was conducted to find the summary estimates. Analyses were performed using STATA 16.
After the screening, 28 studies were eligible to enter the meta-analytic calculations, and data from 15 were reported descriptively. For distinguishing T3/T4 from other T-stages, PET had pooled sensitivity and specificity of 91%(95%CI:72%-97%) and 96%(95%CI:88%-98%), respectively. The sensitivity and specificity for detecting metastatic (regional and/or distant) disease were 100% (95%CI:82%-100%) and 95% (95%CI:90%-98%), respectively. For therapy response assessment, the sensitivity and specificity of PET were 96%(95%CI:78%-99%) and 86%(95%CI:75%-93%), respectively. Higher pre-treatment total metabolic tumour volume was predictive of poorer survival. Conversely, for those achieving complete metabolic response, the 2-year PFS was 94%(95%CI:91%-97%) versus 51%(95%CI:42%-59%) for others (p-value < 0.001).
PET may be a useful tool for anal canal cancer therapy planning and provides valuable prognostic information.
提供关于肛门管癌患者中 [F]-FDG PET（PET）的诊断和预后价值的综合数据。
本研究按照 PRISMA-DTA 指南进行设计。对于荟萃分析，纳入了符合以下标准的已发表的原始文章（截至 2022 年 12 月）：评估了经组织病理学证实的肛门管癌患者的局部区域和/或远处疾病检测中的 PET；将 PET 与有效的参考标准进行比较；提供了用于计算荟萃分析估计值的原始数据。在评估原发性肿瘤检测、T 分期、淋巴结和远处转移时，从亚组计算了诊断测量值。还报告了提供 PET 预后信息的文章作为系统评价。对于汇总荟萃分析计算，使用分层方法。使用二元模型进行汇总估计。使用 STATA 16 进行分析。
筛选后，有 28 项研究有资格进入荟萃分析计算，其中 15 项的结果进行了描述性报告。对于区分 T3/T4 与其他 T 期，PET 的汇总敏感性和特异性分别为 91%（95%CI：72%-97%）和 96%（95%CI：88%-98%）。检测转移性（局部和/或远处）疾病的敏感性和特异性分别为 100%（95%CI：82%-100%）和 95%（95%CI：90%-98%）。对于治疗反应评估，PET 的敏感性和特异性分别为 96%（95%CI：78%-99%）和 86%（95%CI：75%-93%）。较高的治疗前总代谢肿瘤体积预示着生存较差。相反，对于完全代谢反应的患者，2 年无进展生存率为 94%（95%CI：91%-97%），而其他患者为 51%（95%CI：42%-59%）（p 值<0.001）。
PET 可能是肛门管癌治疗计划的有用工具，并提供有价值的预后信息。
