Incidence of Tumour Progression and Pseudoprogression in High-Grade Gliomas: a Systematic Review and Meta-Analysis.
Incidence of Tumour Progression and Pseudoprogression in High-Grade Gliomas: a Systematic Review and Meta-Analysis.
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DOI：
10.1007/s00062-017-0584-x
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发表时间：
2018-09
影响因子：
2.8
通讯作者：
van der Hoorn A
中科院分区：
文献类型：
--
作者：
Abbasi AW;Westerlaan HE;Holtman GA;Aden KM;van Laar PJ;van der Hoorn A
高级别胶质瘤是最常见的原发性脑肿瘤。假性进展描述了MRI上放射诱导进展的假象。应区分真正的肿瘤进展，以正确计划治疗。然而，有广泛的变化，报告的假进展。因此，我们的目的是建立一个系统的审查和荟萃分析高级别胶质瘤患者的假进展和肿瘤进展的发生率。我们检索了PubMed、Embase和Web of Science关于2005年以来成人高级别胶质瘤患者中假进展和肿瘤进展的发生率，最近一次是2014年10月8日。组织学或成像随访用作参考标准。提取的数据包括T1增强后或T2/FLAIR成像结果恶化、假性进展和肿瘤进展的患者数量。评估研究质量。用I2进行异源性检测。使用STATA中的Metaprop（StataCorp. Stata Statistical Software.学院站，TX：StataCorp LP）。我们发现了73项研究。2603例患者发生MRI进展。其中，36%（95%置信区间[CI] 33-40%）的患者出现假进展，60%（95% CI 56-64%）的患者出现肿瘤进展，其余4%（范围1-37%）的患者结局未知。该荟萃分析首次证明了在现有文献中具有某种形式进展的患者中假进展的汇总发生率显著较高。这突出了目前传统的基于MRI的神经肿瘤学缓解评估（RANO）标准在高级别胶质瘤治疗评价中的问题的全部程度。这强调了需要使用先进的成像技术进行更准确的治疗评估，以提高诊断准确性和治疗方法。本文的在线版本（doi：10.1007/s 00062 -017-0584-x）包含补充材料，可供授权用户使用。包含纳入研究的特征（补充表1）和完整检索策略（参见补充检索策略）。
High-grade gliomas are the most common primary brain tumours. Pseudoprogression describes the false appearance of radiation-induced progression on MRI. A distinction should be made from true tumour progression to correctly plan treatment. However, there is wide variation of reported pseudoprogression. We thus aimed to establish the incidence of pseudoprogression and tumour progression in high-grade glioma patients with a systematic review and meta-analysis. We searched PubMed, Embase and Web of Science on the incidence of pseudoprogression and tumour progression in adult high-grade glioma patients from 2005, the latest on 8 October 2014. Histology or imaging follow-up was used as reference standard. Extracted data included number of patients with worsening of imaging findings on T1 postcontrast or T2/FLAIR, pseudoprogression and tumour progression. Study quality was assessed. Heterogeneity was tested with I 2. Pooling of the results was done with random models using Metaprop in STATA (StataCorp. Stata Statistical Software. College Station, TX: StataCorp LP). We identified 73 studies. MRI progression occurred in 2603 patients. Of these, 36% (95% confidence interval [CI] 33–40%) demonstrated pseudoprogression, 60% (95%CI 56–64%) tumour progression and unknown outcome was present in the remaining 4% of the patients (range 1–37%). This meta-analysis demonstrated for the first time a notably high pooled incidence of pseudoprogression in patients with a form of progression across the available literature. This highlighted the full extent of the problem of the currently conventional MRI-based Response Assessment in Neuro-Oncology (RANO) criteria for treatment evaluation in high-grade gliomas. This underscores the need for more accurate treatment evaluation using advanced imaging to improve diagnostic accuracy and therapeutic approach. The online version of this article (doi: 10.1007/s00062-017-0584-x) contains supplementary material, which is available to authorized users. It contains the characteristics of the included studies (supplementary table 1) and a full search strategy (see supplementary search strategy).
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