血清AFP、CEA、CA19-9检测在中国人群肝癌机会性筛查中应用的荟萃分析  

Value of serum AFP,CEA and CA19-9 detection in opportunistic screening for liver cancer in Chinese population:a meta-analysis

作　　者：佟赫 阴建 安耀玉 张凯 Tong He;Yin Jian;An Yaoyu;Zhang Kai(Department of Cancer Prevention,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Cancer Epidemiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院防癌科,北京100021 [2]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院流行病学研究室,北京100021

出　　处：《中华健康管理学杂志》2024年第4期245-253,共9页Chinese Journal of Health Management

基　　金：首都卫生发展科研专项项目(首发2022-2G-40210)。

摘　　要：目的通过荟萃分析评价血清甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)在中国人群肝癌机会性筛查中的应用价值。方法检索中国知网、万方数据库和重庆维普数据库及PubMed、Embase、Cochrane Library从建库至2023年6月收录的AFP、CEA、CA19-9联合筛查肝癌的文献。采用诊断准确性研究的质量评价工具(QUADAS-2)对文献进行质量评价。采用Stata17.0统计软件进行荟萃分析,通过Deeks漏斗图分析文献的发表偏倚。结果共24篇文献符合纳入排除标准,其中肝癌患者组1471例,对照组2150例。AFP在肝癌诊断(筛查)中总灵敏度为0.71(95%CI:0.66~0.75),总特异度为0.86(95%CI:0.80~0.90),综合受试者工作特征曲线(sROC)曲线下面积(AUC)为0.82(95%CI:0.78~0.85);CEA总灵敏度为0.48(95%CI:0.40~0.56),总特异度为0.85(95%CI:0.79~0.89),AUC为0.74(95%CI:0.70~0.77);CA19-9总灵敏度为0.56(95%CI:0.50~0.61),总特异度为0.80(95%CI:0.73~0.85),AUC为0.69(95%CI:0.65~0.73)。三者中AFP灵敏度和特异度均最高。AFP、CEA、CA19-9联合检测总灵敏度提高至为0.89(95%CI:0.85~0.92),总特异度下降到0.77(95%CI:0.70~0.82),AUC为0.91(95%CI:0.88~0.93)。无论单独检测还是联合检测均未发现发表偏倚。结论AFP单独检测灵敏度、特异度均较高,是可用于肝癌机会性筛查的肿瘤标志物。在应用AFP、CEA、CA19-9联合检测筛查肝癌时,应对结果更加谨慎地判读。Objective To evaluate the value of detection of serum alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)in opportunistic screening of liver cancer in Chinese population with a meta-analysis.Methods Literatures on combined screening of liver cancer by AFP,CEA and CA19-9 were retrieved from CNKI,Wanfang Database,Chongqing VIP database,PubMed,Embase and Cochrane Library from the establishment of the databases to June 2023.The Quality Assessment Tool of Diagnostic Accuracy Studies(QUADAS-2)was used to evaluate the quality of the literature.Stata 17.0 statistical software was used for meta-analysis,and Deeks funnel plot was used to analyze publication bias.Results A total of 24 literatures met the inclusion criteria,including 1471 patients with liver cancer and 2150 controls.The overall sensitivity of AFP in liver cancer diagnosis(screening)was 0.71(95%CI:0.66-0.75),the total specificity was 0.86(95%CI:0.80-0.90),and the area under summary receiver operating characteristic(sROC)curve(AUC)was 0.82(95%CI:0.78-0.85).The total sensitivity of CEA in liver cancer diagnosis(screening)was 0.48(95%CI:0.40-0.56),the total specificity was 0.85(95%CI:0.79-0.89),and the AUC of sROC was 0.74(95%CI:0.70-0.77).The total sensitivity of CA19-9 in liver cancer diagnosis(screening)was 0.56(95%CI:0.50-0.61),the total specificity was 0.80(95%CI:0.73-0.85),and the AUC was 0.69(95%CI:0.65-0.73).AFP has the highest sensitivity and specificity among the three.The overall sensitivity of combined detection of AFP,CEA and CA19-9 for liver cancer diagnosis(screening)was increased to 0.89(95%CI:0.85-0.92),the overall specificity was 0.77(95%CI:0.70-0.82),and the AUC was 0.91(95%CI:0.88-0.93).No publication bias was found in either individual or combined test of the biomarkers.Conclusions Detection of AFP alone has high sensitivity and specificity,and it is a tumor marker that can be used for the opportunistic screening of liver cancer.When combined tests of AFP,CEA and CA19-9 are used to screen liver cancer,th

关 键 词：甲胎蛋白 癌胚抗原 糖类抗原19-9 肝癌 机会性筛查 

分 类 号：R735.7[医药卫生—肿瘤] R730.43[医药卫生—临床医学]