超声内镜对早期食管癌术前分期准确性的Meta分析  

Accuracy of endoscopic ultrasound in preoperative staging of early esophageal cancer: A Meta-analysis

作　　者：周思思[1] 严苏[1] 陈卫昌[1] 史冬涛[1] 付婷[1] 

机构地区：[1]苏州大学附属第一医院消化内科,江苏省苏州市215006

出　　处：《世界华人消化杂志》2014年第7期988-999,共12页World Chinese Journal of Digestology

摘　　要：目的:系统评价超声内镜对早期食管癌术前分期的准确性.方法:在计算机上检索Medline、PubMed、Web of Science、Ovid、Cochrane Central Trials databases、万方、CBM、CNKI及维普数据库收集相关文献,检索年限均从建库到2013-05,全面收集国内外有关超声内镜对早期食管癌分期的相关研究,手工检索相关杂志、会议论文集、学位论文汇编等.按照诊断试验的纳入标准筛选文献,提取纳入文献的特征信息(研究背景、设计信息和诊断参数信息),根据诊断性试验质量评价工具(quality assessment of diagnostic accuracy studies,QUADAS)质量评价标准纳入文献的质量.采用Meta-Disc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型.对纳入文献予以加权定量合并,计算汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95%CI,绘制汇总受试者工作特征(summary receiver-operating characteristic curve,SROC)曲线,并计算曲线下面积(area under curve,AUC).然后根据研究对象的特点进行Meta回归分析来寻找潜在引起异质性的因素,同时按Deville介绍的方法筛选并剔除异质性明显的研究进行亚组分析,最后使用Stata10.0软件计算Begg-Mazumdar和HarbordEgger指数来判断发表偏移并绘制漏斗图.结果:纳入文献20篇涉及研究对象共1115例.Meta分析结果提示:超声内镜判断食管黏膜内癌T1m期汇总的敏感度、特异度、阳性似然比及阴性似然比是0.85(95%CI:0.83-0.88),0.8 6(9 5%C I:0.8 3-0.8 9),5.3 4(9 5%C I:3.67-7.76),0.21(95%CI:0.15-0.29);食管黏膜下癌T1sm期汇总的敏感度、特异度、阳性似然比及阴性似然比是0.87(95%CI:0.84-0.90),0.8 5(9 5%C I:0.8 2-0.8 8),4.6 4(9 5%C I:3.47-6.22),0.18(95%CI:0.13-0.25);早期食管癌N期汇总的敏感度、特异度、阳性似然比及阴性似然比是0.71(95%CI:0.61-0.80),0.7 8(9 5%C I:0.7 1-0.8 4),2.9 3(9 5%C I:1.49-5.79),0.46(95%CI:0.18-1.22);T1m期和T1sm期拟合SROCAIM： To evaluate the accuracy of endoscopic ultrasound（EUS） in the preoperative staging of early esophageal cancer. METHODS： We searched the Medline, PubMed, Web of Science, Embase, Cochrane Central Trials, Wanfang, CBM, CNKI and VIP databases for relevant studies published. Study selection, quality assessment and data extraction were performed by two reviewers independently. Meta-Disc（version1.4） software was used to perform the meta-analysis for sensitivity, specificity, positive likelihood ratio（LR）, and negative LR. Pooling results were derived（by） using the fixed-effect model when significant heterogeneity was not present, and the random-effect model was applied otherwise. A summary receiver-operating characteristic（SROC） curve was constructed. Furthermore, to explore the potential sources of heterogeneity, we used metaregression to estimate the effect of the characteristics of the studies on the diagnostic accuracy of EUS. In addition, the outliers were identified by the method described by Deville and a subgroup analysis was performed by excluding the outliers. We used Stata statistical software（version 10.0） to assess the publication bias using the Begg-Mazumdar indictor and Harbord-Egger indictor. RESULTS： Twenty studies with a total of 1115 patients were included in this analysis. The pooled sensitivity, specificity, and positive and negative likelihood ratio of EUS for T1m staging were 0.85（95%CI： 0.83-0.88）, 0.86（95%CI： 0.83-0.89）, 5.34（95%CI： 3.67-7.76）, and 0.21（95%CI： 0.15-0.29）, respectively. For stage T1sm, these results were 0.87（95%CI： 0.84-0.90）, 0.85（95%CI： 0.82-0.88）, 4.64（95%CI： 3.47-6.22）, and 0.18（95%CI： 0.13-0.25）. For stage N, these results were 0.71（95%CI： 0.61-0.80）, 0.78（95%CI： 0.71-0.84）, 2.93（95%CI： 1.49-5.79）, and 0.46（95%CI： 0.18-1.22）. The percent of area under the curve was 92.1% for both stage T1m and stage T1sm, and 80% for stage N. No significant publication bias was found w

关 键 词：内窥镜超声检查 早期食管癌 T1分期 META分析 

分 类 号：R735.1[医药卫生—肿瘤]