血清CEA、CYFRA21-1和CA125检测在非小细胞肺癌机会性筛查中应用价值的荟萃分析  

The value of CEA,CYFRA21-1 and CA125 tests in opportunistic screening for non-small cell lung cancer:a meta-analysis

作　　者：何宏海 张恵恵 吴华[1] 王宏利[1] 赵威[1] 孙萍 王鹏[1] He Honghai;Zhang Huihui;Wu Hua;Wang Hongli;Zhao Wei;Sun Ping;Wang Peng(Physical Examination Center,Peking University Third Hospital,Beijing 100191,China;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)

机构地区：[1]北京大学第三医院体检中心,北京100191 [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防癌科,北京100021

出　　处：《中华健康管理学杂志》2024年第4期254-262,共9页Chinese Journal of Health Management

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2019A12)。

摘　　要：目的基于荟萃分析评价癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)和糖类抗原125(CA125)检测在非小细胞肺癌(NSCLC)机会性筛查中的应用价值。方法检索PubMed、Embase、The Cochrane Library、中国知网、重庆维普数据库和万方数据库从建库到2023年6月收录的关于CEA、CYFRA21-1和CA125检测在中国人群NSCLC诊断价值的原始研究文献。由2名研究者独立按照纳入排除标准进行文献筛选、数据提取和质量评价。采用诊断准确性研究的质量评价工具对文献进行质量评价。使用综合受试者工作特征(SROC)曲线评估试验的总体有效性。分别采用敏感性分析和Deeks′检验漏斗图评估结果的稳定性和文献的发表偏倚。结果根据纳入排除标准,共纳入23篇原始研究。CEA、CYFRA21-1、CA125单独检测诊断NSCLC的总体灵敏度均较低,分别为0.49(95%CI:0.43~0.55)、0.56(95%CI:0.49~0.63)和0.41(95%CI:0.33~0.49)。三者联合检测诊断NSCLC的总体灵敏度虽提高至0.83(95%CI:0.69~0.91),但是总体特异度降低至0.76(95%CI:0.69~0.83)。结论不推荐CEA、CYFRA21-1和CA125单项检测用于健康体检人群中筛查NSCLC,三者联合检测虽然灵敏度提高,但特异度降低,误诊率增加,其筛查效果也有限。Objective To evaluate the value of CEA,CYFRA21-1 and CA125 tests in opportunistic screening of non-small cell lung cancer(NSCLC)based on meta-analysis.Methods The original research literatures on the diagnostic value of CEA,CYFRA21-1 and CA125 in Chinese NSCLC patients were searched from databases of PubMed,Embase,The Cochrane Library,CNKI,VIP,Database and Wanfang database from establishment to June 2023.The literature screening,data extraction and quality evaluation were carried out independently by two researchers.The quality evaluation tool of diagnostic accuracy studies was used to evaluate the quality of the literature.A summary receiver operating characteristic(SROC)curve was used to assess the overall effectiveness of the tests.The outcome stability and publication bias were detected by using sensitivity analysis and Deeks'test.Results A total of 23 studies met the inclusion and exclusion criteria were included.The results of meta-analysis showed that the overall sensitivity of CEA,CYFRA21-1 and CA125 alone in the diagnosis of NSCLC was relatively low,it was 0.49(95%CI:0.43-0.55),0.56(95%CI:0.49-0.63)and 0.41(95%CI:0.33-0.49),respectively.The overall sensitivity of the combined detection of the three markers for the diagnosis of NSCLC increased to 0.83(95%CI:0.69-0.91),but the overall specificity decreased to 0.76(95%CI:0.69-0.83).Conclusions The single detection of CEA,CYFRA21-1 and CA125 is not recommended for screening NSCLC in population receiving physical examination.Although the sensitivity of the combined detection of CEA,CYFRA21-1 and CA125 for screening NSCLC is improved,but the specificity is decreased,the misdiagnosis rate is increased,so the screening effect is limited.

关 键 词：癌 非小细胞肺 肿瘤标记 生物学 癌胚抗原 糖类抗原125 荟萃分析 

分 类 号：R734.2[医药卫生—肿瘤]