Systematic review and meta-analysis of the effect of pre-operative PET/PET-CT in the management of patients with potentially resectable colorectal cancer liver metastasis.
Bibliographic record
Abstract
591 Background: It has been proposed that PET with 18F-fluorodeoxyglucose alone or combined with CT improves detection of extra hepatic disease in the setting of colorectal cancer liver metastasis (CRLM). However, there remains conflicting evidence on the added benefit of PET/PET-CT prior to liver resection, and its effect on long-term survival. Thus, we set out to perform a systematic review of literature and meta-analysis. Methods: From 2000 to April 2017, MEDLINE, EMBASE, and CENTRAL were searched for studies (prospective and retrospective) investigating the preoperative use of PET/PET-CT in the management of patients with CRLM. We excluded studies in which neoadjuvant chemotherapy was given 2 weeks prior to PET/PET-CT. Screening, data abstraction, and quality assessment was performed in duplicate. Primary outcome was overall survival (OS). Secondary outcomes included disease-free survival (DFS), pre-operative change in surgical management, and open-close surgery. Random effect models were used to pool treatment effects. The protocol was published in PROSPERO. Results: Of 4034 articles reviewed, 37 met the inclusion criteria and were analyzed, and 8 compared PET/PET-CT to conventional imaging. All studies included PET (n=18), PET-CT (n=17), or both (n=2). OS for all patients was similar whether or not pre-operative staging included PET/PET-CT (HR 0.94, 95% CI 0.69-1.26). A similar effect was seen in the subgroup of patients who underwent surgery (HR 0.92, 95% CI 0.72-1.17). DFS in patients who underwent surgery was not different either (HR 0.93, 95% CI 0.81-1.08). PET/PET-CT reduced the odds of undergoing an open-close surgery (OR 0.52, 95% CI 0.35-0.76) and changed the surgical management of 23.4% patients (95% CI 19.33-27.47), however heterogeneity (I2=100%). Conclusions: Pre-operative PET/PET-CT may have a meaningful impact on surgical decision making in CRLM, however heterogeneity between studies is high, likely due to different study designs. It may also reduce the rate of open-close surgeries. The addition of PET/PET-CT to routine pre-operative imaging does not improve OS or DFS.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.041 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.034 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".