Csikos Csaba, Czina Péter, Molnár Szabolcs, Kovács Anna Rebeka, Garai Ildikó, Krasznai Zoárd Tibor
Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
Diagnostics (Basel). 2024 Aug 10;14(16):1740. doi: 10.3390/diagnostics14161740.
The cornerstone of ovarian cancer treatment is complete surgical cytoreduction. The gold-standard option in the absence of extra-abdominal metastases and intra-abdominal inoperable circumstances is primary cytoreductive surgery (CRS). However, achieving complete cytoreduction is challenging, and only possible in a selected patient population. Preoperative imaging modalities such as [F]FDG PET/CT could be useful in patient selection for cytoreductive surgery. In our systematic review and meta-analysis, we aimed to evaluate the role of preoperative [F]FDG PET/CT in predicting complete cytoreduction in primary and secondary debulking surgeries. Publications were pooled from two databases (PubMed, Mendeley) with predefined keywords "(ovarian cancer) AND (FDG OR PET) AND (cytoreductive surgery)". The quality of the included studies was assessed with the Prediction model Risk Of Bias Assessment Tool (PROBAST). During statistical analysis, MetaDiSc 1.4 software and the DerSimonian-Laird method (random effects models) were used. Primary and secondary cytoreductive surgeries were evaluated. Pooled sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) were calculated and statistically analyzed. Results were presented in forest plot diagrams and summary receiver operating characteristic (SROC) curves. Overall, eight publications were included in our meta-analysis. Four publications presented results of primary, three presented results of secondary cytoreductions, and two presented data related to both primary and secondary surgery. Pooled sensitivities, specificities, and positive and negative predictive values were the following: in the case of primary surgeries: 0.65 (95% CI 0.60-0.71), 0.73 (95% CI 0.66-0.80), 0.82 (95% CI 0.77-0.87), 0.52 (95% CI 0.46-0.59); and in the case of secondary surgeries: 0.91 (95% CI 0.84-0.95), 0.48 (95% CI 0.30-0.67), 0.88 (95% CI 0.81-0.93), 0.56 (95% CI 0.35-0.75), respectively. The PPVs of [F]FDG PET/CT proved to be higher in cases of secondary debulking surgeries; therefore, it can be a valuable predictor of complete successful secondary cytoreduction.
卵巢癌治疗的基石是彻底的手术细胞减灭术。在没有腹外转移和腹腔内无法手术的情况下，金标准选择是初次细胞减灭术（CRS）。然而，实现彻底的细胞减灭具有挑战性，并且仅在特定的患者群体中才有可能。术前成像方式，如[F]FDG PET/CT，在细胞减灭术的患者选择中可能有用。在我们的系统评价和荟萃分析中，我们旨在评估术前[F]FDG PET/CT在预测初次和二次肿瘤细胞减灭术中彻底细胞减灭的作用。从两个数据库（PubMed、Mendeley）中收集了带有预定义关键词“（卵巢癌）AND（FDG或PET）AND（细胞减灭术）”的出版物。使用预测模型偏倚风险评估工具（PROBAST）评估纳入研究的质量。在统计分析过程中，使用了MetaDiSc 1.4软件和DerSimonian-Laird方法（随机效应模型）。对初次和二次细胞减灭术进行了评估。计算并统计分析了合并敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果以森林图和汇总受试者工作特征（SROC）曲线呈现。总体而言，我们的荟萃分析纳入了8篇出版物。4篇出版物展示了初次手术的结果，3篇展示了二次细胞减灭术的结果，2篇展示了与初次和二次手术相关的数据。合并敏感性、特异性以及阳性和阴性预测值如下：在初次手术的情况下：0.65（95%CI 0.60 - 0.71），0.73（95%CI 0.66 - 0.80），0.82（95%CI 0.77 - 0.87），0.52（95%CI 0.46 - 0.59）；在二次手术的情况下：分别为0.91（95%CI 0.84 - 0.95），0.48（95%CI 0.30 - 0.67），0.88（95%CI 0.81 - 0.93），0.56（95%CI 0.35 - 0.75）。[F]FDG PET/CT的PPV在二次肿瘤细胞减灭术的情况下被证明更高；因此，它可以成为成功实现彻底二次细胞减灭的有价值预测指标。
