End-therapy Positron Emission Tomography For Treatment Response Assessment And Prognosis In Burkitt's Lymphoma: A Systematic Review And Meta-analysis

Objectives: End-therapy positron emission tomography for treatment response assessment and prognosis in Burkitt lymphoma is still a controversial issue. Here, We adopt a systematic review and meta-analysis to assess the value of post-treatment FDG-PET for Burkitt's lymphoma and to determine the PET / CT value in Burkitt's lymphoma patients. This provides the basis for the clinical application of PET in Burkitt's lymphoma patients.Research design: In Pub Med, Embase databases, Ovid-MEDLINE database, we searched comprehensive literature on assessing treatment response and prognostic value of end-treatment PET and/or CT of Burkitt lymphoma. Then we screened the literature, evaluated the methodological quality of the included studies, extracted trial data of the studies, and used Revman5.3 software for meta-analysis.Results: Based on the search strategy, there are seven documents included a total of 257 patients enrolled in the study.Seven literatures all reported complete remission rate of the disease, the result of meta-analysis shows that, PET(-) group compared to PET(+) group, the complete remission rate was significantly higher(RR = 1.95, 95% confidence interval value of 1.11-3.43). Seven literatures all reported relapse rate during follow-up, the result of shows that, PET(-) group compared to PET(+) group, the recurrence rate was significantly different(RR value = 0.23, 95% CI 0.08-0.70), the relapse rate of PET(-) group was significantly lower than PET(+) group, and the difference is statistically significant. But for the patients that use other conventional imaging methods(including CT, X-ray, ultrasound imaging, etc., mostly CT, hereinafter referred to as CT group) to assess the response to therapy, both in remission and relapse rates, CT(-) group and CT(+) group were not statistically significantly different(response rate RR value = 1.16, 95% CI 0.97-1.37; recurrence rate RR value = 0.78, 95% CI 0.52-1.18).Two articles reported the 3-year progression-free survival(PFS) survival curves of the patients that have different PET and CT results. We made use of PS technology and Engauge-Digitizer software for data extraction, then use Revman5.3 software integration hazard ratio(HR), the results shows that, the progression-free survival(PFS) is no significant difference when PET(-) group compared to PET(+) group(HR value = 0.24, 95% confidence interval 0.13-2.13); Similarly, CT(-) group and CT(+) group is not significantly different, too(HR value = 0.92, 95% CI 0.16-5.22).Conclusions: PET has a distinct advantage in the assessment of remission and relapse rates. The complete remission rate of the patients in PET(-) group is significantly higher than in the PET(+) group, and the relapse rates is significantly lower, and the difference is statistically significant. Yet, the complete remission rate of the patients in CT(-) group is higher than in the CT(+) group, and the relapse rates is lower, but it is not statistically significant because of the 95% confidence interval of them includes 1. PET and CT have no clear meaning in the assessment of survival indicators such as PFS.