Table_1_5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis.docx

BackgroundSeveral studies have confirmed the impact of 5-aminolevulinic acid (5-ALA) on the extent of resection in newly diagnosed glioblastoma (GBM). However, there are controversies on the 5-ALA fluorescence status in recurrent GBM surgery, with specific reference to pseudoprogression or radionecrosis; therefore, the safety and accuracy of surgical planning in 5-ALA-assisted procedures in the recurrent context are still unclear.
Materials and MethodsThis is a systematic review and meta-analysis of comparative studies on the use of 5-ALA in newly diagnosed and recurrent GBM, consistently conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data on fluorescence status and correlation between fluorescence and histological findings were collected. We performed a meta-analysis of proportions to estimate the pooled rates of each outcome.
ResultsThree online medical databases (PubMed, Scopus, Cochrane Library) were screened, 448 articles were evaluated, and 3 papers were finally included for data analysis. Fluorescence rate was not different between newly diagnosed and recurrent GBM [p = 0.45; odds ratio (OR): 1.23; 95% CI: 0.72–2.09; I2 = 0%], while the rate of 5-ALA fluorescence-positive areas not associated with histological findings of GBM cells was higher in recurrent GBM (p = 0.04; OR: 0.24; 95% CI: 0.06–0.91; I2 = 19%). Furthermore, there were no cases of radionecrosis in false-positive samples, while inflammation and signs of pseudoprogression were found in 81.4% of the cases.
Discussion and ConclusionsTherefore, a robust awareness of 5-ALA potentialities and pitfalls in recurrent GBM surgery should be considered for a cognizant surgical strategy. Further clinical trials could confirm the results of the present meta-analysis.

背景
多项研究已证实5-氨基酮戊酸（5-aminolevulinic acid，5-ALA）对新诊断胶质母细胞瘤（glioblastoma，GBM）的肿瘤切除范围具有影响。然而，针对复发胶质母细胞瘤手术中的5-ALA荧光状态，现有研究尚存争议，尤其聚焦于假性进展或放射性坏死的相关场景；因此，复发情境下5-ALA辅助手术的安全性与手术规划准确性仍未明确。

材料与方法
本研究为一项系统综述与荟萃分析，针对新诊断与复发胶质母细胞瘤中5-ALA应用的对比性研究展开，严格遵循《系统评价和荟萃分析首选报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）规范执行。研究收集了荧光状态数据，以及荧光表现与组织学检查结果之间的相关性数据。我们采用比例荟萃分析方法，以估算各项结局指标的合并发生率。

结果
共检索PubMed、Scopus、Cochrane Library这3个在线医学数据库，初筛获得448篇文献，最终纳入3篇文献用于数据分析。新诊断与复发胶质母细胞瘤的荧光发生率无显著统计学差异[ p = 0.45；优势比（odds ratio，OR）：1.23；95%置信区间（confidence interval，CI）：0.72~2.09；I² = 0%]；而复发胶质母细胞瘤中，5-ALA荧光阳性区域与胶质母细胞瘤细胞组织学表现不相关的比例更高（p = 0.04；OR：0.24；95%CI：0.06~0.91；I² = 19%）。此外，假阳性样本中未检出放射性坏死病例，而81.4%的假阳性样本可见炎症表现与假性进展征象。

讨论与结论
因此，在复发胶质母细胞瘤手术中，临床医师需充分认知5-ALA的应用价值与潜在局限，以制定审慎合理的手术策略。未来可开展进一步临床试验以验证本荟萃分析的研究结果。