目的:目前的临床建议是部署经批准的经放射性标记的前列腺特异性膜抗原-配体正电子发射断层扫描(PSMAPET)来检测原发性转移性前列腺癌。然而,这种配体在定位前列腺内肿瘤(索引肿瘤)和T分期中的确切功效尚未得到很好的确定。因此,本研究的目的是通过一项荟萃分析,结合以组织学确认为参考标准的研究,确定PSMA-PET在新诊断前列腺癌肿瘤分期中的诊断准确性.
方法:在本研究中,我们对PubMed进行了系统的文献检索,Embase,WebofScience,和CochraneLibrary数据库使用预定义的搜索词集合。这些术语包括“PSMAPET”,\'主分期\',和“前列腺癌”。随后,两名独立评审员根据预定的纳入标准评估了所有研究,提取相关数据,并评估证据的质量。任何差异都由第三位审阅者解决。随机效应Sidik-Jonkman模型用于进行荟萃分析,并在每个患者的基础上估计诊断准确性。以及95%的置信区间。此外,利用Egger检验和漏斗图的图形检查,对发表偏倚的可能性和小型研究效应的影响进行了评估.
结果:本分析共包含23篇科学论文,包括969名患者,并通过定性和定量方法进行分析。这项研究的结果表明,PSMAPET/CT和PSMAPET/MRI的估计诊断准确性,用于检测前列腺内肿瘤,无论PSMA-配体的类型,分别为86%(95%CI:76-96%)和97%(95%CI:94-100%),分别。此外,前列腺外延伸(EPE)检测的诊断准确性为73%(95%CI:64-82%)和77%(95%CI:69-85%),而检测精囊受累(SVI)的诊断准确性为87%(95%CI:80-93)和90%(95%CI:82-99%),分别。
结论:本研究表明,PSMAPET/MRI在诊断准确性方面超过了当前推荐的多参数磁共振成像(mpMRI),这是从显着的数据轨迹推断的。而PSMA-PET/CT在前列腺内肿瘤检测和T分期方面的诊断准确性与mpMRI相当。然而,分析发现了某些潜在的局限性,如小型研究效应和潜在的发表偏倚,这可能会影响从本研究中得出的总体结论。
The current clinical recommendations posit the deployment of specific approved radiolabeled prostate-specific membrane antigen-ligand positron emission tomography (PSMA PET) for detecting metastatic prostate cancer during primary staging. Nevertheless, the precise efficacy of such ligands in localizing intraprostatic tumours (index tumour) and T-staging is not well established. Consequently, the objective of this inquiry is to ascertain the diagnostic accuracy of PSMA-PET in the tumour staging of newly diagnosed prostate cancer by means of a meta-analysis that integrates studies utilizing histological confirmation as the reference standard.
In this study, we conducted a systematic literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases using a predefined collection of search terms. These terms included \'PSMA PET\', \'primary staging\', and \'prostate cancer\'. Subsequently, two independent reviewers evaluated all the studies based on predetermined inclusion criteria, extracted pertinent data, and assessed the quality of evidence. Any disparities were resolved by a third reviewer. A random effects Sidik-Jonkman model was applied to conduct a meta-analysis and estimate the diagnostic accuracy on a per-patient basis, along with 95% confidence intervals. Moreover, an appraisal regarding the likelihood of publication bias and the impact of small-study effects was performed utilizing both Egger\'s test and a graphical examination of the funnel plot.
The present analysis comprised a total of twenty-three scientific papers encompassing 969 patients and involved their analysis by both qualitative and quantitative approaches. The results of this study demonstrated that the estimated diagnostic accuracy of PSMA PET/CT and PSMA PET/MRI, for the detection of intraprostatic tumours, regardless of the type of PSMA-ligand, was 86% (95% CI: 76-96%) and 97% (95% CI: 94-100%), respectively. Furthermore, the diagnostic accuracy for the detection of extraprostatic extension (EPE) was 73% (95% CI: 64-82%) and 77% (95% CI: 69-85%), while the diagnostic accuracy for the detection of seminal vesicle involvement (SVI) was 87% (95% CI: 80-93) and 90% (95% CI: 82-99%), respectively.
The present investigation has demonstrated that PSMA PET/MRI surpasses currently recommended multiparametric magnetic resonance imaging (mpMRI) in terms of diagnostic accuracy as inferred from a notable data trajectory, whereas PSMA-PET/CT exhibited comparable diagnostic accuracy for intraprostatic tumour detection and T-staging compared to mpMRI. Nevertheless, the analysis has identified certain potential limitations, such as small-study effects and a potential for publication bias, which may impact the overall conclusions drawn from this study.