膀胱肿瘤抗原和尿细胞学检测诊断膀胱癌的Meta分析

Bladder Cancer Antigen BTA stat and Urine Cytology in Bladder Cancer Diagnosis:A Meta-analysis

目的系统评价膀胱肿瘤抗原(BTAstat)和尿细胞学检测对膀胱癌的诊断意义。方法制定原始文献的纳入、排除标准及检索策略,检索MEDLINE(1966.1～2008.6)、EMbas(e1988.1～2008.6)、Cochrane图书馆(2008年第1期)、CMCC(1979～2008.6)、CNK(I1979.1～2008.6),收集有关BTAstat和尿细胞学比较诊断膀胱癌的文献。采用QUADAS进行质量评价。用MetaDiSc1.4软件进行Meta分析。结果共检索到相关研究71篇,排除58篇,纳入符合标准的13篇文献进行Meta分析,共3733例。异质性检验提示无阈值效应,但存在其它原因导致的异质性。用随机效应模型进行Meta分析。BTAstat和尿细胞学诊断膀胱癌的敏感度、特异度、阳性似然比、阴性似然比及诊断优势比分别为0.68(0.65,0.70)、0.74(0.72,0.76)、2.51(2.04,3.09)、0.46(0.38,0.55)、5.66(3.87,8.29)和0.41(0.39,0.44)、0.97(0.97,0.98)、12.64(7.58,21.08)、0.62(0.55,0.71)、22.16(12.38,39.66)。两者的敏感性随肿瘤分级和分期的升高而增高,且对初发膀胱肿瘤的敏感性较复发高。两者的综合受试者工作特征曲线下面积分别为0.7535和0.7119,Q*指数分别为0.6963和0.6624。结论BTAstat对膀胱肿瘤的诊断准确度中等,尚不能取代传统的尿细胞学检查,更不能单独用于膀胱癌的诊断,但可作为膀胱镜检查的重要辅助手段,是诊断膀胱癌可选的无创性检查方法。

Objective To systematic review of bladder cancer antigen （BTA） stat and urine cytology （UC） in the diagnosis of bladder cancer. Methods MEDLINE （Jan.1966 to June 2008）, EMbase （Jan.1988 to June,2008）, Cochrane Library （Issue 1,2008）, CMCC （1979 to June, 2008） and CNKI （Jan.1979 to June, 2008） were searched for studies about BTA stat and cytology in the diagnosis of bladder cancer. The search strategy was made according to the Collaborative Review Group search strategy. Quality of included trials wa assessed by quality assessment of diagnostic accuracy studies.Data were extracted by two reviewers using the designed extraction form. The software MetaDiScl.4 was used to review management and data analysis. Results In total, 71 relevant studies were searched, of which 13 were included and 58 were excluded, with 3 733 patients involved. Heterogeneity （except for threshold effect） was found within these studies. A meta-analysis was performed using random effect model. Pooled accuracy indicators of sensitivity, specificity, positive likelihood ratio （LR）, negative LR and diagnostic odds ratio （dOR） and 95%CI ofBTA stat and UC were 0.68 （0.65,0.70）, 0.74 （0.72, 0.76）, 2.51 （2.04, 3.09）, 0.46 （0.38, 0.55）, 5.66 （3.87, 8.29） and 0.41 （0.39, 0.44）, 0.97 （0.97, 0.98）, 12.64 （7.58, 21.08）, 0.62 （0.55, 0.71）, 22.16 （12.38, 39.66）, respectively. The sensitivity of both methods increased as the higher of tumor grade and stage, and the incipient tumor was higher than the recurrence. Area under curve （AUC） of SROC curve of BTA stat and UC were 0.753 5 and 0.711 9, and Q＊ index were 0.696 3 and 0.662 4, respectively. Conclusions The performance of urine BTA stat is moderate in the diagnosis of bladder tumor. It can not replace the traditional urine cytology and diagnose the bladder cancer alone, but which can be an available noninvasive examination and an important adjunct of preoperative detecting and postoperative monitoring of bladder tumor.