胰液中K-ras基因突变检测对胰腺癌诊断效能的荟萃分析

Detection of K-ras gene mutation in pancreatic juice for diagnasis of pancreatic cancer:a meta-analysis

目的系统评价胰液中K—ras基因第12位密码子点突变对胰腺癌的诊断效能。方法电子检索获得胰液中K—ras基因突变诊断胰腺癌的研究文献。筛选文献并提取纳入研究中有关准确度的数据。采用MetaDiSc1．4软件检验研究间的异质性并进行荟萃（Meta）分析，Stata10．0软件评价发表偏倚的影响。结果共纳入文献15篇，异质性检验无阈值效应，研究间在不同点突变检测方法、随机化方法及实验盲法上无异质性。合并统计量，K—ras基因突变诊断胰腺癌的敏感度、特异度、诊断优势比分别为0．61（95％CI 0．56～0．66），0．82（95％CI 0．77～0．86）和6．28（95％CI 4．42～8．91）；综合受试者工作特征曲线下面积AUC=0．8207，Q^＊=o．7542。失安全系数Nfs0.05=694．0108，发表偏倚对Meta分析结果的影响较小。结论胰液中K—ras基因突变检测对胰腺癌的诊断效能中等，作为胰腺癌的早期诊断或筛查指标尚嫌不足，但可作为细胞学、影像学、酶学等检查的重要补充。

Objective To systematically assess the detection of K-ras gene mutation at codon 12 in pancreatic juice for diagnosis of pancreatic cancer. Methods A comprehensive electronic searching was performed to retrieve relevant studies on K-ras gene mutation in pancreatic juice for diagnosis of pancreatic cancer. Data on accuracy of included studies were extracted, Meta-DiSel. 4, Stata lO. 0, was applied for further heterogeneity exploring, meta-analysis and publication bias testing. Results Fifteen studies met the inclusion criteria. Heterogeneity was not found among these studies, including threshold effect, different test methods, randomization and blind. Pooled accuracy indicators like sensitivity, specificity and diagnostic odds ratio （DOR） were0.61（95%CI0.56-0.66）, 0.82（95%CI 0.77-0.86） and 6. 28 （ 95 % CI 4. 42 - 8.91 ） , respectively. Area under curve （ AUC ） of SROC （ summary receiver operating characteristics ） was 0. 8207 and Q index was 0. 7542. Publication bias had little influence on meta-analysis with the fail-safe number of 694. 0108. Conclusions This meta-analysis demonstrates that the detection of K-ras gene mutation in pancreatic juice has moderate effect for diagnosis of pancreatic cancer. It is not enough to be an early diagnosing or screening indicator for pancreatic cancer, but it can be used clinically as an important adjunct to cytology, imageology and enzymology in the diagnosis of pancreatic cancer.