PSA和f/t PSA比值在中国人群前列腺癌筛查中诊断价值的荟萃分析  

Diagnostic value of PSA and free-to-total PSA ratio in prostate cancer screening in Chinese people:a meta-analysis

作　　者：赵静[1] 慈晓伟 阴建 董建[1] 张凯 褚熙[1] Zhao Jing;Ci Xiaowei;Yin Jian;Dong Jian;Zhang Kai;Chu Xi(Health Management Department,Xuanwu Hospital,Capital Medical University,Beijing 100054,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;Department of Cancer Epidemiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100021,China)

机构地区：[1]首都医科大学宣武医院健康管理科,北京100054 [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 [3]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12期916-923,共8页Chinese Journal of Health Management

摘　　要：目的分析前列腺特异性抗原(PSA)和游离与总前列腺特异性抗原(f/t PSA)比值在中国人群前列腺癌筛查中的诊断价值。方法检索Pubmed、Embase、Cochrane、中国知网、万方数据库和维普数据库从建库至2023年6月收录的关于PSA和f/t PSA比值在前列腺癌检测中诊断价值的原始研究文献。利用诊断准确性研究的偏倚评估工具评估文献质量,Stata 15.1软件包进行荟萃分析。结果共纳入了26篇文献,研究总共涵盖了18407人,其中4095人依据穿刺活检和术后病理检查被确诊为前列腺癌,其余为前列腺其他疾病患者或健康人群。以PSA>4.0 ng/ml范围作为前列腺癌筛查的临界值的文章24篇,合并灵敏度0.88(95%CI:0.84~0.91),特异度0.42(95%CI:0.34~0.50),综合受试者工作特征(SROC)曲线下面积(AUC)为0.77(95%CI:0.73~0.81)。以PSA>10.0 ng/ml作为前列腺癌筛查临界值的文章4篇(其中3篇文章采用了两种临界值分别计算),合并灵敏度0.83(95%CI:0.74~0.89),特异度0.67(95%CI:0.45~0.84),SROC曲线AUC为0.79(95%CI:0.75~0.83)。以f/t PSA比值作为筛查前列腺癌的有11篇文章。当f/t PSA比值<0.16时,合并灵敏度0.82(95%CI:0.76~0.87),特异度0.76(95%CI:0.67~0.83),SROC曲线AUC为0.86(95%CI:0.83~0.89)。结论在中国人群前列腺癌筛查中PSA具有较高灵敏度,f/t PSA比值具有较高特异性,建议联合应用。Objective To evaluate the diagnostic value of PSA and the f/t PSA ratio in prostate cancer screening in Chinese people.Methods Original articles on the application of PSA and f/t PSA ratio in prostate cancer screening among Chinese population were retrieved from Pubmed,Embase,Cochrane,China National Knowledge Infrastructure(CNKI),Wanfang data and VIP databases from the establishment of the database to June 2023.The literature quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)tool.A meta-analysis was performed with Stata 15.1 software.Results A total of 26 articles were included,encompassing 18407 individuals,of whom 4095 were diagnosed with prostate cancer based on biopsy and postoperative pathological examination,while the rest were patients with other prostate diseases or healthy individuals.24 used a PSA threshold of>4.0 ng/ml as the cutoff for prostate cancer screening,the pooled sensitivity was 0.88(95%CI:0.84-0.91),the specificity was 0.42(95%CI:0.34-0.50),and the area under the summary receiver operating characteristic(SROC)curve(AUC)was 0.7(95%CI:0.73-0.81).Four articles considered a PSA threshold of>10.0 ng/ml for prostate cancer screening(three of which used the above two cutoff values),the pooled sensitivity was 0.83(95%CI:0.74-0.89),the specificity was 0.67(95%CI:0.45-0.84),and the AUC of the SROC was 0.79(95%CI:0.75-0.83).Eleven articles used the f/t PSA ratio as a screening tool for prostate cancer.When the f/t PSA ratio was<0.16,the pooled sensitivity was 0.82(95%CI:0.76-0.87),the specificity was 0.76(95%CI:0.67-0.83),and the AUC of the SROC was 0.86(95%CI:0.83-0.89).Conclusion In the screening for prostate cancer in China,PSA has a relatively high sensitivity,and the f/t PSA ratio has a better specificity.Combined application of the two indices is recommended.

关 键 词：前列腺肿瘤 前列腺特异抗原 诊断 荟萃分析 

分 类 号：R737.25[医药卫生—肿瘤]