Abstract
Early prediction of treatment response in nasopharyngeal carcinoma is clinically relevant for optimizing treatment strategies. This meta-analysis was performed to evaluate whether apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) can predict treatment response of patients with nasopharyngeal carcinoma. A systematic search of PubMed-MEDLINE and Embase was performed to identify relevant original articles until July 22, 2021. We included studies which performed DWI for predicting locoregional treatment response in nasopharyngeal carcinoma treated with neoadjuvant chemotherapy, definitive chemoradiation, or radiation therapy. Hazard ratios were meta-analytically pooled using a random-effects model for the pooled estimates of overall survival, local relapse-free survival, distant metastasis-free survival and their 95% CIs. ADC showed a pooled sensitivity of 87% (95% CI 72–94%) and specificity of 70% (95% CI 56–80%) for predicting treatment response. Significant between-study heterogeneity was observed for both pooled sensitivity (I2 = 68.5%) and specificity (I2 = 92.2%) (P < 0.01). The pooled hazard ratios of low pretreatment ADC for assessing overall survival, local relapse-free survival, and distant metastasis-free survival were 1.42 (95% CI 1.09–1.85), 2.31 (95% CI 1.42–3.74), and 1.35 (95% CI 1.05–1.74), respectively. In patients with nasopharyngeal carcinoma, pretreatment ADC demonstrated good predictive performance for treatment response.
Highlights
Nasopharyngeal cancer (NPC) is a common subtype of head-and-neck cancers prevalent in Asia and Africa, with about 129,000 new cases reported in 2 0181
The purpose of this systematic review and meta-analysis was to assess the predictive performance of pretreatment apparent diffusion coefficient (ADC) for treatment response in patients with NPC
After full-text review, nine articles were further excluded because they were not in the field of interest (n = 1)[28], had overlapping study populations (n = 2)[10,29], had insufficient information for the reconstruction of 2 × 2 tables (n = 1)[30], insufficient detail of pretreatment ADC (n = 3)[31,32,33], or region of interest was on lymph nodes only (n = 2)[34,35]
Summary
This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) g uidelines[20]. The inclusion criteria were: (1) population: patients with histologically proven NPC who underwent neoadjuvant chemotherapy, definitive chemoradiation, or radiation therapy; (2) index test: DWI MRI with provision for pretreatment ADC of primary NPC; (3) reference standard: the reference standards of the treatment outcome as determined by histology, clinical/imaging follow-up, or a combination of these; (4) outcomes: locoregional failure after neoadjuvant chemotherapy, definitive chemoradiation, or radiation therapy reported in sufficient detail; and (5) study design: all observational studies (retrospective or prospective). Two reviewers (blinded and blinded) with seven years of experiences in the head and neck diagnostic radiology independently extracted the data and performed a quality assessment. Data extraction and quality assessment were performed independently by two reviewers (blinded and blinded).
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