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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Medicine+(Baltimore)
2015 ; 94
(6
): e517
Nephropedia Template TP
gab.com Text
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English Wikipedia
Effectiveness of the apparent diffusion coefficient for predicting the response
to chemoradiation therapy in locally advanced rectal cancer: a systematic review
and meta-analysis
#MMPMID25674749
Xie H
; Sun T
; Chen M
; Wang H
; Zhou X
; Zhang Y
; Zeng H
; Wang J
; Fu W
Medicine (Baltimore)
2015[Feb]; 94
(6
): e517
PMID25674749
show ga
The efficacy of the different apparent diffusion coefficients (ADCs) in
predicting different responses to preoperative chemoradiation therapy (CRT) in
patients with locally advanced rectal cancer (LARC) is controversial. We did this
meta-analysis to evaluate the efficacy of different ADCs predicting different
responses to CRT in patients with LARC.We systematically searched the MEDLINE,
Embase, and Cochrane Library databases for articles published from January 1,
1990, to June 3, 2014. Pooled estimates were calculated using a bivariate
random-effects model for the ADCs before and after CRT (pre- and post-ADC), as
well as the change between the pre- and post-ADC (?ADC). The values of the 3 ADCs
for judging different response endpoints, which were defined according to the
tumor grading (TRG) system and downstaging of T (tumor) or N (nodal) stages (TN
downstaging), were assessed.We included 16 studies with a total of 826 patients.
The sensitivity, specificity, DOR, and AUC were 75% (95% CI 57%-87%), 70% (95% CI
50%-84%), 6.81 (95% CI 2.46-18.88), and 0.79 (95% CI 0.75-0.82), respectively,
for the pre-ADC in predicting a good response; 76% (95% CI 63%-85%), 87% (95% CI
78%-92%), 20.68 (95% CI 11.76-36.39), and 0.89 (95% CI 0.86-0.91), respectively,
for the post-ADC; and 78% (95% CI 65%-87%), 77% (95% CI 62%-87%), 11.82 (95% CI
4.65-30.04), and 0.84 (95% CI 0.81-0.87), respectively, for the ?ADC. The
post-ADC demonstrated the highest specificity and DOR (P?0.001), although
sensitivity did not differ between the 3 types of ADC (P?=?0.380, 0.192, and
0.214). For predicting a pathological complete response (pCR), the post-ADC had
the highest specificity (P?0.001and 0.030) but lowest sensitivity (P?0.001).
The ?ADC had the highest DOR; however, this difference was not statistically
significant (P?=?0.146).The ADC is a reliable and reproducible measure and could
serve as a promising noninvasive tool for evaluating the response to CRT in
patients with LARC; the post-ADC and ?ADC are particularly promising. The ?ADC
had the highest diagnostic performance to predict a pCR compared with the pre-ADC
and post-ADC. The value of the ADCs to predict T or N downstaging requires
further investigation.