循环游离DNA对前列腺癌诊断价值的Meta分析  

Diagnostic Value of Circulating Cell-free DNA to Prostate Cancer:a Meta-analysis

作　　者：李凡[1] 徐宾[1] 向慧 陈泽佳 庞子森 张天禹[1] LI Fan;XU Bin;XIANG Hui;CHEN Zejia;PANG Zisen;ZHANG Tianyu(Department of Urology,Affiliated Hospital of Guilin Medical University,Guilin 541001,China;Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Guilin Medical University,Guilin 541001,China)

机构地区：[1]桂林医学院附属医院泌尿外科,广西桂林市541001 [2]桂林医学院附属医院呼吸与危重症医学科,广西桂林市541001

出　　处：《中国全科医学》2021年第20期2580-2588,2600,共10页Chinese General Practice

基　　金：桂林医学院中青年教职工科研能力提升项目(2018glmcy100)。

摘　　要：背景众多研究表明循环游离DNA(cfDNA)对前列腺癌有诊断价值,但关于cfDNA检测前列腺癌的准确性并不一致。目的进一步明确cfDNA对前列腺癌的诊断价值。方法检索PubMed、EMBase、Web of Science、The Corchrane Library、中国知网、万方数据知识服务平台等数据库,收集所有符合纳入标准的中英文文献,提取第一作者的姓名、发表年份、国家、样本量、检测方法及研究数据参数(真阳性、假阳性、假阴性、真阴性)等信息,检索年限自建库至2020年2月。采用Spearman秩相关分析探讨有无阈值效应,并通过汇总受试者工作特征曲线(SROC曲线)判断SROC图形是否呈“肩臂状”,运用Corchran-Q检验、I2检验分析纳入研究间的异质性,并根据异质性大小选择合适模型进行合并。通过Meta分析评估cfDNA的诊断效能,绘制Fagan图评估cfDNA的诊断能力。结果共纳入22篇文献,2774例研究对象包括1936例前列腺癌患者和838例非前列腺癌患者,纳入文献整体质量较好。Meta分析结果显示,cfDNA诊断前列腺癌的合并灵敏度(Sen_(合并))为0.49〔95%CI(0.47,0.51)〕,合并特异度(Spe_(合并))为0.91〔95%CI(0.89,0.92)〕,合并阳性似然比(PLR_(合并))为6.04〔95%CI(4.39,9.31)〕,合并阴性似然比(NLR_(合并))为0.52〔95%CI(0.45,0.60)〕,合并诊断比值比(DOR_(合并))为18.19〔95%CI(12.33,26.85)〕。相应的SROC曲线下面积(AUC)为0.8982。亚组分析显示cfDNA对前列腺癌的诊断效能的AUC在各个亚组中并无明显改变(P>0.05)。Fagan图显示,设定验前概率为20%,然后辅以检测cfDNA,诊断前列腺癌的准确率为88%。结论cfDNA诊断前列腺癌有一定价值,可能有助于早期发现前列腺癌,但仍有待于大量的证据进一步验证。Background Numerous studies have shown that circulating free DNA(cfDNA)has diagnostic value in prostate cancer,but there is no consensus on its accuracy.Objective To evaluate the diagnostic value of cfDNA in prostate cancer by a Meta-analysis.Methods Articles in Chinese and English regarding diagnosing prostate cancer using cfDNA were collected by searching databases of PubMed,EMBase,Web of Science,The Cochrane Library,CNKI,and WANFANG DATA from inception to February 2020,and were enrolled according to the inclusion and exclusion criteria.Data were extracted,including the first author's name,year of publication,country of publication,sample size,detection method and accuracy assessment indices(true-positive,false-positive,false-negative,true-negative).Spearman correlation was used to assess whether there was a threshold effect.The SROC plot was used to examine whether the diagnostic performance curve of cfDNA presenting a“shoulder-arm”shape.The heterogeneity between the included studies was measured by the Cochran's Q test and I2 test and used for selecting an appropriate model for pooling data.Meta-analysis and Fagan's nomogram were used to estimate the diagnostic efficiency and probability of cfDNA,respectively.Results Twenty-two articles were included,involving 2774 cases,1936 of whom were diagnosed with prostatic cancer by cfDNA and 838 were not.The overall quality of the included literature was good.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio of cfDNA for prostate cancer diagnosis were 0.49〔95%CI(0.47,0.51)〕,0.91〔95%CI(0.89,0.92)〕,6.04〔95%CI(4.39,9.31)〕,0.52〔95%CI(0.45,0.60)〕,and 18.19〔95%CI(12.33,26.85)〕,respectively.The AUC of the SROC curve was 0.8982.Subgroup analysis showed that the AUC value of cfDNA in the diagnosis of prostate cancer did not change significantly in each subgroup(P>0.05).Fagan's nomogram demonstrated that using cfDNA to detect prostatic cancer increased the posttest probability to 88% from the pre

关 键 词：前列腺肿瘤 循环游离DNA META分析 诊断 

分 类 号：R737.25[医药卫生—肿瘤]