PET/CT和CT诊断宫颈癌腹主动脉淋巴结转移间接比较的Meta分析  

Diagnostic value of PET/CT and CT for para-aortic metastatic lymph nodes in patients with cervical cancer:a Meta-analysis and indirect comparison

作　　者：张家华[1,2] 葛龙[1,2] 田金徽[2,3] 李金龙[1] 杨克虎[2,3] 

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学循证医学中心,甘肃兰州730000 [3]兰州大学甘肃省循证医学与临床转化重点实验室,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2015年第1期34-42,共9页Journal of Lanzhou University（Medical Sciences）

基　　金：国家自然科学基金项目(81373882)

摘　　要：目的 采用Meta分析和间接比较方法评价PET/CT和CT在宫颈癌腹主动脉淋巴结转移诊断中的临床价值.方法 计算机检索PubMed （1966-2013.7）、Web of Science （1980-2013.7）、The Cochrane Library （2013.6）、Embase （1974-2013.7）、中文科技期刊数据库（1989-2013.7）、万方数据库（1990-2013.7）、中国知网数据库（1994-2013.7）、中国生物医学文献数据库（1978-2013.7）,并辅以手工检索,获取PET/CT诊断宫颈癌腹主动脉淋巴结转移的相关文献.2名研究者严格按照纳入排除标准独立地筛选文献,提取资料,依据诊断准确性研究的质量评估（QUADAS）工具进行文献质量评价.用Meta-Disc 1.4和Statal2.0软件对PET/CT诊断宫颈癌腹主动脉淋巴结转移的敏感性（SEN）、特异性（SPE）、阳性似然比（＋LR）、阴性似然比（-LR）、诊断比值比（DOR）进行合并分析和间接比较,并进行异质性检验.计算综合受试者工作特征（SROC）曲线下面积.间接比较结果计算相对诊断比值比（RDOR）等.结果 检索获得1 006条记录,最终纳入27篇文献,共4469例患者.Meta分析结果显示,以术后病理检查为金标准,PET/CT诊断宫颈癌腹主动脉淋巴结转移的SEN合并为0.70 （95％CI 0.65～0.74）,SPE合并为0.96 （95％CI 0.95～0.96）,DOR为24.53 （95％CI 10.83～55.57）,SROC曲线下面积为0.8705;CT诊断宫颈癌腹主动脉淋巴结转移的SEN合并为0.65 （95％CI 0.57～0.73）,SPE合并为0.87 （95％CI 0.84～0.90）,DOR为12.59 （95％CI 8.36～18.95）,SROC曲线下面积为0.8720.间接比较结果显示PET/CT与CT的RDOR值为1.95 （95％CI 0.69～5.50）.结论 PET/CT较CT诊断宫颈癌腹主动脉淋巴结转移准确性高,可作为宫颈癌淋巴结转移的诊断方法之一.Objective To evaluate the diagnostic value of PET/CT and CT in detecting the para-aortic metastat- ic lymph nodes in patients with cervical cancer. Methods We systematically searched PubMed（1966-2013.7）, EMBASE（1974-2013.7）, Cochrane Library（2013.6）, Chinese Technological Periodical Full-text Database （1989-2013.7）, Wanfang Database （1990-2013.7）, China National Kmowledge Infrastructure （1994-2013.7）, and Chinese Biomedical Literature Database （1978-2013.7）. And manual retrieval was also performed to find potential studies. The studies of PET/CT and CT in the diagnosis of para-aortic metastatic lymph nodes of cervical cancer were included. Data extraction was performed by two independent reviewers. QUADAS （Quality assessment of diagnostic accuracy studies） items were used to evaluate the quality of included stud- ies. Meta-disc 1.4 and Statal2.0 software were usedto synthesize data. Using the sensitivity, specificity, diag- nostic odds ratio, summary receiver operating characteristic （SROC） to assess the diagnostic value of included studies. The results of indirect comparison were expressed as relative ratio. Results 27 studies met the eligible criteria, involving 4 469 patients. The results of meta-analysis showed postoperative pathologic examination as gold standard, the sensitivity, specificity, diagnostic odds ratio, and AUROC of PET/CT for the para-aortic metastatic lymph nodes in patients with cervical cancer were 0.70 （95%CI 0.65-0.74）, 0.96 （95%CI 0.95- 0.96）, 24.53 （95%CI 10.83-55.57）, and 0.8705, respectively, and 0.65 （95%CI 0.57-0.73）, 0.87 （95%CI 0.84- 0.90）, 12.59 （95%CI 8.36-18.95）, and 0.8720, respectively for CT. The results of indirect comparison showed that PET/CT was better than CT in detecting the para-aortic metastatic lymph nodes in patients with cervical cancer. Conclusion PET/CT method could be regarded as an more effective and feasible method than CT for para-aortic metastatic lymph nodes in patients with cervical cancer.

关 键 词：宫颈癌 PET/CT 淋巴结转移 META分析 

分 类 号：R737.33[医药卫生—肿瘤] R817.4[医药卫生—临床医学]