title: Can Diffusion-weighted Magnetic Resonance Imaging Predict Survival in Patients with Cervical Cancer? A Meta-Analysis.
abstract: OBJECTIVE
  Although diffusion-weighted magnetic resonance imaging (DWI) has been widely used in the diagnosis of cervical cancer, whether it can predict disease recurrence or survival remains inconclusive. This study aimed to systematically evaluate whether DWI can serve as a reliable prognostic predictor in patients with cervical cancer.
  
  
  METHODS
  PubMed, the MEDLINE database and the Cochrane Library were searched for DWI studies with >12 months of prognostic data in patients with cervical cancer. Endpoints included tumor recurrence and death. Methodological quality was assessed using the Quality in Prognostic Studies (QUIPS) tool. Combined estimates of hazard ratios (HRs) were derived.
  
  
  RESULTS
  Nine studies involving a total of 796 patients (mean/median age from 45.0 years to 62.9 years) met the inclusion criteria. Methodological quality was relatively high. Eight of the nine studies employed apparent diffusion coefficient (ADC) as an indicator of DWI results. Using disease-free survival (DFS) as an outcome measure, nine studies yielded a combined HR of 1.55 (95% confidence interval (CI): 1.23-1.95), and seven studies that employed pretreatment DWI yielded a combined HR of 1.50 (95% CI: 1.03-2.19), which indicated that unfavorable DWI results were associated with an approximately 1.50-1.55-fold higher risk of tumor recurrence. The two studies investigating the impact of DWI results on overall survival (OS) reported HRs of 7.20 and 2.17, respectively.
  
  
  CONCLUSIONS
  DWI may serve as a predictor of tumor recurrence in patients with cervical cancer as showed by meta-analysis, and the quantified ADC as a suitable candidate indicator.
authors.affiliation: Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, No. 32, Section 2, 1st Ring Road (West), Chengdu 610072, Sichuan, China. Electronic address: wangyuting_330@163.com.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Wang
authors.affiliation: Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, No. 32, Section 2, 1st Ring Road (West), Chengdu 610072, Sichuan, China. Electronic address: anicespringspring@163.com.
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Li
authors.affiliation: Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, No. 32, Section 2, 1st Ring Road (West), Chengdu 610072, Sichuan, China. Electronic address: yinlonglin@163.com.
authors.forename: Long-Lin
authors.initials: LL
authors.lastname: Yin
authors.affiliation: Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, No. 32, Section 2, 1st Ring Road (West), Chengdu 610072, Sichuan, China. Electronic address: ph196797@163.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Pu
mesh_terms: D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005544:Forecasting; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: ADC; Cervical cancer; DWI; Disease free survival; MRI; Recurrence