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Meta-Analysis
. 2018 Sep;28(3):401-411.
doi: 10.1007/s00062-017-0584-x. Epub 2017 May 2.

Incidence of Tumour Progression and Pseudoprogression in High-Grade Gliomas: a Systematic Review and Meta-Analysis

Abdul W Abbasi  1 , Henriette E Westerlaan  1 , Gea A Holtman  2 , Kamal M Aden  1 , Peter Jan van Laar  1   3 , Anouk van der Hoorn  4   5
Affiliations
Meta-Analysis

Incidence of Tumour Progression and Pseudoprogression in High-Grade Gliomas: a Systematic Review and Meta-Analysis

Abdul W Abbasi et al. Clin Neuroradiol. 2018 Sep.

Abstract

Background: High-grade gliomas are the most common primary brain tumours. Pseudoprogression describes the false appearance of radiation-induced progression on MRI. A distinction should be made from true tumour progression to correctly plan treatment. However, there is wide variation of reported pseudoprogression. We thus aimed to establish the incidence of pseudoprogression and tumour progression in high-grade glioma patients with a systematic review and meta-analysis.

Methods: We searched PubMed, Embase and Web of Science on the incidence of pseudoprogression and tumour progression in adult high-grade glioma patients from 2005, the latest on 8 October 2014. Histology or imaging follow-up was used as reference standard. Extracted data included number of patients with worsening of imaging findings on T1 postcontrast or T2/FLAIR, pseudoprogression and tumour progression. Study quality was assessed. Heterogeneity was tested with I 2 . Pooling of the results was done with random models using Metaprop in STATA (StataCorp. Stata Statistical Software. College Station, TX: StataCorp LP).

Results: We identified 73 studies. MRI progression occurred in 2603 patients. Of these, 36% (95% confidence interval [CI] 33-40%) demonstrated pseudoprogression, 60% (95%CI 56-64%) tumour progression and unknown outcome was present in the remaining 4% of the patients (range 1-37%).

Conclusion: This meta-analysis demonstrated for the first time a notably high pooled incidence of pseudoprogression in patients with a form of progression across the available literature. This highlighted the full extent of the problem of the currently conventional MRI-based Response Assessment in Neuro-Oncology (RANO) criteria for treatment evaluation in high-grade gliomas. This underscores the need for more accurate treatment evaluation using advanced imaging to improve diagnostic accuracy and therapeutic approach.

Keywords: High-grade gliomas; Incidence; Meta-analysis; Pseudoprogression; Treatment response assessment.

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Conflict of interest statement

Conflict of interest

A.W. Abbasi, H.E. Westerlaan, G.A. Holtman, K.M. Aden, P.J. van Laar and A. van der Hoorn declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Flowchart demonstrating the inclusion and exclusion of studies
Fig. 2
Fig. 2
Quality assessment of included studies. The risk of bias in four different domains and concerns about applicability are shown for the included studies. High risk (red −), unclear risk (yellow ?) and low risk (green +)
Fig. 3
Fig. 3
Forest plot of pooled incidences for treatment induced pseudoprogression. Squares represent the weighted estimate with the solid line indicating the 95% CI. The dashed line represents the group estimate
See this image and copyright information in PMC

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