应用^(18)FDGPET评价食管癌新辅助治疗疗效的价值

The evaluation of response to neoadjuvant therapy using ^(18)FDG PET in esophageal cancer

背景与目的:食管癌患者采用新辅助治疗有望提高其预后,因此新辅助治疗的疗效评价非常关键。目前,18FDGPET被认为是评价食管癌新辅助治疗疗效最佳的检查方法。本研究采用Meta分析方法系统评价18FDGPET对食管癌新辅助治疗疗效的诊断价值。方法:通过MEDLINE及EMBASE数据库检索、收集公开发表的应用18FDGPET评价食管癌新辅助治疗疗效的所有英文文献。对收集到的文献参照QUADAS系统进行质量评估。对符合标准的入选文献数据进行统计处理,计算综合敏感度、特异度及诊断优势比;根据Moses’线性模型绘制SROC曲线,计算曲线下面积及Q*值。结果:入选的13篇文献均满足QUADAS质量评价系统所列评估项目。18FDGPET评价食管癌新辅助治疗疗效的综合敏感度为70.3%(95%CI:64.4%～75.8%),综合特异度为70.1%(95%CI:65.1%～74.8%),综合诊断优势比为9.389(95%CI:3.482～25.319);SROC曲线下面积为0.8244,Q*值为0.7575。结论:18FDGPET作为一种无创性分子影像诊断技术,在评价食管癌患者接受新辅助治疗疗效上具有较高的诊断价值。

Background and purpose：Neoadjuvant therapy in esophageal cancer is introduced in an effort to improve prognosis.Response assessment is crucial for the treatment of these patients.Currently,FDG-PET seems to be the best available tool for neoadjuvant therapy response assessment in esophageal cancer.The purpose of this study was to assess the diagnostic value of 18FDG PET for the evaluation of neoadjuvant therapy response in esophageal cancer with a meta-analysis.Methods：All the studies published in the English language for 18FDG PET assessing neoadjuvant therapy response in esophageal cancer in MEDLINE and EMBASE database were collected.Methodological quality of the included studies was evaluated according to the QUADAS quality assessment tool.Pooled sensitivity,specifi city,diagnostic odds ratio and SROC （summary receiver operating characteristic curves） were obtained using statistical software.Results：Thirteen studies included in the meta-analysis fulfilled the inclusion criteria listed in the QUADAS quality assessment requirements.The pooled sensitivity,specifi city and diagnostic odds ratio for 18FDG PET in the evaluation of neoadjuvant therapy response in esophageal cancer were 70.3% （95%CI：64.4%-75.8%）,70.1% （95%CI：65.1%-74.8%） and 9.389 （95%CI：3.482-25.319）,respectively.The area under the curve and Q＊ value in SROC were 0.824 4 and 0.757 5.Conclusion：As a no injury imaging test,18FDG PET is valuable for the assessment of neoadjuvant therapy response in esophageal cancer.