Prognostic value of (18)F-fluorodeoxyglucose bone marrow uptake in patients with solid tumors: A meta-analysis

BACKGROUND: Several studies have reported the prognostic value of (18)F-fluorodeoxyglucose ((18)F-FDG) bone marrow uptake (BMU) measured by (18)F-FDG positron emission tomography ((18)F-FDG PET) in various cancers. We performed a meta-analysis to evaluate the prognostic value of (18)F-FDG BMU in patients with solid tumors. METHODS: Systematic searches of MEDLINE and Embase databases were performed using the keywords “(18)F-FDG,” “bone marrow,” and “prognosis.” All published human studies of the prognostic value of (18)F-FDG BMU in patients with solid tumors were searched. The primary outcome was event-free survival (EFS), and the secondary endpoint was overall survival (OS); both of these were extracted directly from each study. The effects of (18)F-FDG BMU on survival were assessed by using hazard ratios (HRs). RESULTS: Ten studies with 1197 patients (8 studies reporting EFS in 1096 patients and 7 studies reporting OS in 836 patients) were included. In the EFS analysis, the combined HR was 1.75 (95% confidence interval [CI]: 1.45–2.11, P < .00001) in the random effects model (I(2) = 51%, P = .05). The combined HR of OS was 1.40 (95% CI: 1.13–1.73, P = .002) in the random effects model (I(2) = 52%, P = .05). CONCLUSION: This meta-analysis has demonstrated that patients with a low level of (18)F-FDG BMU have better EFS and OS than those with a high level of (18)F-FDG BMU. Based on our results, we suggest that (18)F-FDG BMU could be used as a biomarker for stratifying the risk of tumor progression in patients with solid tumors.