~(18)F-FDG PET/CT预测胃肠道间质瘤对伊马替尼治疗反应的Meta分析
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摘要
目的通过Meta分析评价18F-FDG正电子发射计算机体层摄影(PET/CT)预测胃肠间质瘤对伊马替尼治疗反应的价值。方法检索PubMed、EMBASE、Web of science、Cochrane图书馆、中国知网、万方和中国生物医学数据库建库以来到2018年3月公开发表的PET/CT预测胃肠间质瘤对伊马替尼治疗反应的前瞻性试验,经2名研究人员进行数据提取和质量评价后,采用Meta-Disc软件进行双变量随机效应模型的Meta分析。通过绘制受试者操作特征(ROC)曲线并计算曲线下面积(AUC),计算纳入研究的合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、合并诊断比值比以及相应的95%置信区间(95%CI)。将接受治疗的药物类型和治疗后PET/CT的检查时间进行亚组分析,采用Meta回归探讨非阈值效应引起的异质性。结果共纳入6项研究,包括115例病人。纳入研究的合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、合并诊断比值比和AUC分别为0.88(95%CI:0.77～0.96)、0.64(95%CI:0.49～0.78)、2.03(95%CI:1.04～3.95)、0.27(95%CI:0.13～0.55)、11.43(95%CI:2.82～46.41)和0.8771。Meta回归分析显示所接受的治疗药物和治疗后PET/CT检查的时间对诊断价值的影响差异无统计学意义(P=0.29和0.68)。Deek’s漏斗图提示存在发表偏倚的可能性(P=0.04)。结论 18F-FDG PET/CT用于预测胃肠间质瘤对伊马替尼的治疗反应具有较高的敏感度和特异度。
Objective To assess the treatment response of imatinib in gastrointestinal stromal tumors with18 F-FDG PET/CT using meta-analysis method. Methods We searched PubMed, EMBASE, Web of Science, Cochrane Library,CNKI, Wanfang and CBM from their inception to March 2018, to include prospective tests of assessing the treatment response of imatinib in gastrointestinal stromal tumors using18 F-FDG PET/CT. Two reviewers independently extracted data and assessed the quality of the included studies. Meta-analysis with bivariate random effects model was conducted using MetaDisc software. The receiver operating characteristic(ROC) curve was plotted and the area under curve(AUC) was calculated.The pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood, pooled diagnostic odds ratio and their corresponding 95% confidence interval(95%CI) were calculated. We conducted subgroup analyses based on the type of drugs received and the examination date of PET/CT after treatment. Meta-regression was performed to explore the sources of heterogeneity beyond threshold effect. Results Six studies involving 115 patients were included. Meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio, and AUC were 0.88(95%CI: 0.77, 0.96), 0.64(95%CI: 0.49, 0.78), 2.03(95%CI: 1.04, 3.95), 0.27(95%CI: 0.13, 0.55), 11.43(95%CI: 2.82, 46.41), and 0.8771, respectively. Meta-regression presented that the drugs used and the examination date of PET/CT after treatment did not significantly influence the diagnostic value(P=0.29, and 0.68).Deek's test indicated the possibility of publication bias(P=0.04). Conclusions The sensitivity and specificity were good for18 F-FDG PET/CT to predict the treatment response of imatinib in gastrointestinal stromal tumors.
Objective To assess the treatment response of imatinib in gastrointestinal stromal tumors with18 F-FDG PET/CT using meta-analysis method. Methods We searched PubMed, EMBASE, Web of Science, Cochrane Library,CNKI, Wanfang and CBM from their inception to March 2018, to include prospective tests of assessing the treatment response of imatinib in gastrointestinal stromal tumors using18 F-FDG PET/CT. Two reviewers independently extracted data and assessed the quality of the included studies. Meta-analysis with bivariate random effects model was conducted using MetaDisc software. The receiver operating characteristic(ROC) curve was plotted and the area under curve(AUC) was calculated.The pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood, pooled diagnostic odds ratio and their corresponding 95% confidence interval(95%CI) were calculated. We conducted subgroup analyses based on the type of drugs received and the examination date of PET/CT after treatment. Meta-regression was performed to explore the sources of heterogeneity beyond threshold effect. Results Six studies involving 115 patients were included. Meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio, and AUC were 0.88(95%CI: 0.77, 0.96), 0.64(95%CI: 0.49, 0.78), 2.03(95%CI: 1.04, 3.95), 0.27(95%CI: 0.13, 0.55), 11.43(95%CI: 2.82, 46.41), and 0.8771, respectively. Meta-regression presented that the drugs used and the examination date of PET/CT after treatment did not significantly influence the diagnostic value(P=0.29, and 0.68).Deek's test indicated the possibility of publication bias(P=0.04). Conclusions The sensitivity and specificity were good for18 F-FDG PET/CT to predict the treatment response of imatinib in gastrointestinal stromal tumors.
引文
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[10]Antoch G,Kanja J,Bauer S,et al.Comparison of PET,CT,and dual-modality PET/CT imaging for monitoring of imatinib(STI571)therapy in patients with gastrointestinal stromal tumors[J].J Nucl Med,2004,45:357-365.
[11]Maurel J,Martins AS,Poveda A,et al.Imatinib plus low-dose doxorubicin in patients with advanced gastrointestinal stromal tumors refractory to high-dose imatinib:a phase I-II study by the Spanish group for research on sarcomas[J].Cancer,2010,116:3692-3701.
[12]Fuster D,Ayuso JR,Poveda A,et al.Value of FDG-PET for monitoring treatment response in patients with advanced GIST refractory to high-dose imatinib.A multicenter GEIS study[J].Q J Nucl Med Mol Imaging,2011,55:680-687.
[13]Bertagna F,Bosio G,Orlando E,et al.Role of F-18-FDG-PET/CTin restaging of patients affected by gastrointestinal stromal tumours(GIST)[J].Nuclear Medicine Review,2010,13:76-80.
[14]Zukotynski K,Yap JT,Giobbie-Hurder A,et al.Metabolic response by FDG-PET to imatinib correlates with exon 11 KIT mutation and predicts outcome in patients with mucosal melanoma[J].Cancer Imaging,2014,14:30-39.
[15]Chacón M,Eleta M,Espindola AR,et al.Assessment of early response to imatinib 800 mg after 400 mg progression by18F-fluorodeoxyglucose PET in patients with metastatic gastrointestinal stromal tumors[J].Fut Oncol,2015,11:953-964.
[16]梁雪,畅通,胡思畅,等.胃肠道间质瘤的免疫治疗研究进展[J].细胞与分子免疫学杂志,2017,33:715-718.
[2]Scherubl H,Faiss S,Knoefel WT,et al.Management of early asymptomatic gastrointestinal stromal tumors of the stomach[J].World JGastrointest Endosc,2014,6:266-271.
[3]Ford SJ,Gronchi A.Indications for surgery in advanced/metastatic GIST[J].Eur J Cancer,2016,63:154-167.
[4]姚中杨.伊马替尼、舒尼替尼治疗失败的胃肠道间质瘤三线治疗的荟萃分析[D].山东大学,2015.
[5]Asija AP,Mejia AV,Prestipino A,et al.Gastrointestinal stromal tumors:a review[J].Am J Ther,2016,23:e550-e557.
[6]Nishida T,Blay JY,Hirota S,et al.The standard diagnosis,treatment,and follow-up of gastrointestinal stromal tumors based on guidelines[J].Gastric Cancer,2016,19:3-14.
[7]Shreve P,Faasse T.Role of positron emission tomography-computed tomography in pulmonary neoplasms[J].Radiol Clin,2013,51:767-779.
[8]Whiting PF,Rutjes AW,Westwood ME,et al.QUADAS-2:a revised tool for the quality assessment of diagnostic accuracy studies[J].Ann Intern Med,2011,155:529-536.
[9]Valls-Ferrusola E,García-Garzón JR,Ponce-López A,et al.Patterns of extension of gastrointestinal stromal tumors(GIST)treated with imatinib(Gleevec誖)by18F-FDG PET/CT[J].Rev Esp Enferm Dig,2012,104:360-366.
[10]Antoch G,Kanja J,Bauer S,et al.Comparison of PET,CT,and dual-modality PET/CT imaging for monitoring of imatinib(STI571)therapy in patients with gastrointestinal stromal tumors[J].J Nucl Med,2004,45:357-365.
[11]Maurel J,Martins AS,Poveda A,et al.Imatinib plus low-dose doxorubicin in patients with advanced gastrointestinal stromal tumors refractory to high-dose imatinib:a phase I-II study by the Spanish group for research on sarcomas[J].Cancer,2010,116:3692-3701.
[12]Fuster D,Ayuso JR,Poveda A,et al.Value of FDG-PET for monitoring treatment response in patients with advanced GIST refractory to high-dose imatinib.A multicenter GEIS study[J].Q J Nucl Med Mol Imaging,2011,55:680-687.
[13]Bertagna F,Bosio G,Orlando E,et al.Role of F-18-FDG-PET/CTin restaging of patients affected by gastrointestinal stromal tumours(GIST)[J].Nuclear Medicine Review,2010,13:76-80.
[14]Zukotynski K,Yap JT,Giobbie-Hurder A,et al.Metabolic response by FDG-PET to imatinib correlates with exon 11 KIT mutation and predicts outcome in patients with mucosal melanoma[J].Cancer Imaging,2014,14:30-39.
[15]Chacón M,Eleta M,Espindola AR,et al.Assessment of early response to imatinib 800 mg after 400 mg progression by18F-fluorodeoxyglucose PET in patients with metastatic gastrointestinal stromal tumors[J].Fut Oncol,2015,11:953-964.
[16]梁雪,畅通,胡思畅,等.胃肠道间质瘤的免疫治疗研究进展[J].细胞与分子免疫学杂志,2017,33:715-718.