^(99m) Tc-MIBI显像预测骨肉瘤新辅助化疗后组织学反应的Meta分析  

^(99m) Tc-MIBI scintigraphy for prediction of histological response to neoadjuvant chemotherapy in osteosarcoma:a Meta-analysis

作　　者：马玉萍 谢彦[2] 靳激扬[3] MA Yuping;XIE Yan;JIN Jiyang(School of Medicine,Southeast University,Nanjing 210009,China;Department of Nuclear Medicine,Zhongda Hospital,Southeast University,Nanjing 210009,China;Department of Radiology,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[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

出　　处：《东南大学学报（医学版）》2021年第1期15-22,共8页Journal of Southeast University(Medical Science Edition)

基　　金：江苏省卫生健康委医学科研项目(H2019091)。

摘　　要：目的:通过汇总运用锝-99m-甲氧基异丁基异腈(technetium-99m-sestambi,^(99m) Tc-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^(99m) Tc-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^(99m) Tc-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^(99m) Tc-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(^(99m) Tc-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.Aχ^(2) 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:^(99m) Tc-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%.

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[医药卫生—肿瘤]