Meta Analysis Of Radio-chemotherapeutic Efficacy Of Cervical Cancer With Diffusion-weighted Magnetic Resonance Imaging

Purpose:A Meta analysis of the high quality Chinese and English articles on the evaluation of radio-chemotherapeutic efficacy of MR diffusion weighted imaging(ADC)in cervical cancer was carried out,and the application of DWI ADC value in evaluating the efficacy of radiotherapy and chemotherapy for cervical cancer was discussed.Materials and methods:To search for articles on radiotherapy and chemotherapy of cervical cancer,diffusion weighted MR imaging(ADC)of cervical cancer in Chinese databases,such as “CNKI”,“Wangfang”?“CBM”and English search database PubMed ?EMBASE and Cochrane library.The retrieval time is from 2001 to October 2017.According to the pre-designed retrieval sentences,all the documents were preliminarily searched,the title of the documents were read,the abstracts were read,andthe obviously irrelevant documents and the documents that did not meet the inclusion criteria were eliminated.Finally,the remaining documents were thoroughly read in depth,according to the inclusion,The exclusion criteria are re-screened to determine the theme,research design,outcome indicators,etc.The document retrieval process was completed by two researchers,and the two researchers were selected according to their own judgment to participate in the analysis of the literature and to discuss it.When the two researchers had different opinions,they reached an agreement through discussion,if there were still differences.After consulting the third evaluator,the three discussed making the decision.Finally,15 selected articles on the evaluation of radio-chemotherapeutic efficacy of magnetic resonance diffusion-weighted imaging for cervical cancer were extracted from relevant data.The extracted data included a basic description of the study(first author,published year),the study population(sample,age,type of chemoradiotherapy),technical parameters(MR instrument type b,average ADC value and standard deviation before and after treatment).Results:15 articles were collected,including 5 articles in Chinese(2013-2017)and 10 articles in English(2009-2016).A total of 727 patients with cervical cancer received radiotherapy and chemotherapy.REVMAN5.3 software was used to analyze the 15 articles obtained,and the literature evaluation was carried out according to the classification criteria of QUADAS-2 items from the selection of cases,the test to be evaluated,and the gold standard.The four aspects of case flow and progress were evaluated and 15 articles were of high quality.The chi-square test is used to test the heterogeneity of the literatures(P ? 0.10),which shows that the paper has heterogeneity,and the random effect model is chosen.The average ADC value before radiotherapy and chemotherapy and the average ADC value after radiotherapy and chemotherapy were statistically analyzed by stata13.0software in 15 articles.The standardized average difference(SMD)of 15 articles was-3.85,95% CI:-4.64 ~-3.08,P=0.000,the difference was statistically significant.The results showed that the average ADC value of patients with cervicalcancer after radiotherapy and chemotherapy was higher than that of patients with cervical cancer before radiotherapy and chemotherapy.The heterogeneity of the 15 articles obtained was95.9%,and the language in which the article was published was selected(Chinese and English),b value was defined as 600s/mm2(higher than 600s/mm2 as a high b value,Lower than600s/mm2 was determined as low b value).The number of patients(50 cases as the limit)and the diagnostic method of curative effect after radiotherapy and chemotherapy(pathological section,RECIST standard and tumor withdrawal rate)were analyzed as subgroups.Considering the diagnostic method of therapeutic effect after radiotherapy and chemotherapy may be a potential source of heterogeneity.In addition,although we do not conduct a subgroup analysis based on research design,research design is likely to be one of the potential sources of heterogeneity.After Egger's and Begg's test,the value of p ? 0.1 as the test.The test p=0.000 and P =0.004 which are smaller than that standard,which indicates that there is a publication deviation in 15 articles obtained.There was no significant difference in the standardized mean differenceand the 95% confidence interval between the sensitivity analysis and the elimination of the literature,which indicated that the stability of the literature included was good and the reliability of the literature was high.Conclusion:Meta analysis was performed on 15 Chinese and English literatures about the quality of radiotherapy and chemotherapy of cervical cancer evaluated by Mr diffusion weighted imaging.The results showed that the average ADC value of cervical cancer patients with effective radiotherapy and chemotherapy would be higher than the average ADC value of cervical cancer before the quality of radiotherapy and chemotherapy.Therefore,diffusion-weighted magnetic resonance imaging(ADC)can be used as an important index to predict the curative effect of radiotherapy and chemotherapy for cervical cancer.