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99mTc-MIBI显像预测骨肉瘤新辅助化疗后组织学反应的Meta分析
作者:马玉萍1  谢彦2  靳激扬3 
单位:1. 东南大学 医学院, 江苏 南京 210009;
2. 东南大学附属中大医院 核医学科, 江苏 南京 210009;
3. 东南大学附属中大医院 放射科, 江苏 南京 210009
关键词:骨肉瘤 新辅助化疗 锝-99m-甲氧基异丁基异腈显像 肿瘤坏死率 预后 Meta分析 
分类号:R738.1
出版年·卷·期(页码):2021·40·第一期(15-22)
摘要:

目的:通过汇总运用锝-99m-甲氧基异丁基异腈(technetium-99m-sestambi,99mTc-MIBI)显像计算甲氧基异丁基异腈(MIBI)摄取值化疗前后变化率(AUR)及化疗前99mTc-MIBI显像扫描早期与延迟期摄取值衰减率(WR)预测骨肉瘤新辅助化疗后组织学反应的文献,分析AUR和WR对评估骨肉瘤新辅助化疗反应的价值。方法:在PubMed、Web of Science、Elsevier、中国知网和万方数据库检索运用99mTc-MIBI显像预测骨肉瘤化疗后组织学反应的文献,提取文献中真阳性值、假阳性值、假阴性值及真阴性值,并分别制成2×2四格表;利用Meta-DiSc 1.4软件进行Meta分析,计算不同截断值的加权灵敏度、特异度,绘制受试者工作特征曲线(ROC曲线),并计算曲线下面积(AUC)。结果:共纳入8篇文献中6篇研究利用AUR预测肿瘤坏死率(TNR),合计134例患者:当AUR截断值为30%时,加权诊断灵敏度、特异度和AUC分别为0.85(95%CI:0.74~0.93)、0.59(95%CI:0.47~0.70)及0.84;当AUR截断值为35%时,加权诊断灵敏度、特异度和AUC分别为0.91(95%CI:0.79~0.98)、0.68(95%CI:0.55~0.79)及0.87;当AUR截断值为38%时,加权诊断灵敏度、特异度和AUC分别为0.87(95%CI:0.72~0.96)、0.80(95%CI:0.66~0.89)及0.91。4篇研究运用WR预测TNR,合计96例患者:当WR截断值为22%时,加权诊断灵敏度、特异度和AUC分别为0.57(95%CI:0.37~0.75)、0.94(95%CI:0.85~0.98)及0.90;当WR截断值为25%时,加权诊断灵敏度、特异度和AUC分别为0.70(95%CI:0.51~0.85)、0.86(95%CI:0.76~0.94)及0.87。结论:(1)运用99mTc-MIBI显像,尤其是利用AUR≥38%和WR≤25%作为截断值,可以早期及无创地预测骨肉瘤新辅助化疗后的组织学反应;(2)AUR≥38%的预测能力优于WR≤25%。

Objective: To evaluate the predicting value of technetium-99m-sestambi (99mTc-MIBI) scintigraphy in the assessment of histological response to neoadjuvant chemotherapy in patients with osteosarcomas. Methods: A detailed search was made in Web of Science, PubMed, Elsevier, China National Knowledge Infrastructure (CNKI), Wanfang database for relevant original articles published in English or Chinese, up to April 2020; methodological quality of the included studies were also assessed. Two reviewers extracted data. Sufficient data were presented to construct a 2×2 contingency table. Pooled sensitivity, specificity were estimated. A summary receiver operating characteristic curve(ROC curve) was constructed. A χ2 test was performed to test for heterogeneity. The Der Simonian and Laird random effect model was applied if significant heterogeneity between studies was observed, while a fixed effect model was used in the absence of significant between-study heterogeneity. Results: Eight studies met the inclusion criteria. Six studies searched the relationship between alteration uptake ratio(AUR) and tumor necrosis ratio(TNR), including 134 patients. The pooled sensitivity, specificity and area under the ROC curve(AUC) for AUR ≥ 30% were 0.85(95%CI:0.74-0.93), 0.59(95%CI:0.47-0.70) and 0.84;for AUR ≥ 35% were 0.91(95%CI:0.79-0.98),0.68(95%CI:0.55-0.79) and 0.87;for AUR ≥ 38% were 0.87(95%CI:0.72-0.96), 0.80(95%CI:0.66-0.89) and 0.91, respectively. There were four studies revealing the relationship between washout rate(WR) and TNR, including 96 patients. The pooled sensitivity, specificity and AUC for WR ≤ 22% were 0.57(95%CI:0.37-0.75), 0.94(95%CI:0.85-0.98) and 0.90;for WR ≤ 25% were 0.70(95% CI:0.51-0.85), 0.86(95%CI:0.76-0.94) and 0.87, respectively. Conclusion: 99mTc-MIBI imaging, especially using AUR ≥ 38% and WRAUR ≤ 25% as cut-off values, can early and non-invasively predict histological response after neoadjuvant chemotherapy in osteosarcoma, and the predictive ability of AUR ≥ 38% is better than that of WRAUR ≤ 25%.

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