PSA及F/T对中国人群前列腺癌早期诊断的系统评价

PSA and F/T test for early detection of the prostate cancer in Chinese:a systematic review and Meta analysis

目的评价前列腺特异性抗原(prostate-specific antigen,PSA)及游离PSA与总PSA的比值(F/T)在中国人群前列腺癌早期诊断中的价值。方法以MEDLINE、中国生物医学文献数据库、中国生物医学期刊文献数据库、中国学术期刊全文数据库与中文科技期刊全文数据库为主进行文献检索,再根据已发表文献中的参考文献追溯进行手工检索。检索期限为1990年1月到2005年6月。按确定的纳入标准筛选文献,对纳入的文献进行质量评价,运用Cochrane协作网诊断与筛查小组推荐的SROC曲线法,对PSA分别以>4 ng/ml、>10 ng/ml以及F/T<0.15作为临界点的敏感度、特异度、准确性、SROC曲线下面积(AUC)等指标行Meta分析。结果共检索到69篇中文文献,4篇英文文献。其中10篇文献,共2 256例病例符合纳入标准。PSA分别以>4 ng/ml、>10 ng/ml以及F/T<0.15作为临界点对诊断前列腺癌的敏感度分别为90%、65%和69%;特异度分别为58%、87%和82%;SROC AUC分别为80%、85%和86%。结论以PSAF/T<0.15作为诊断前列腺癌的界值,具有较高的鉴别准确性,尚可应用于中国人群。

Objective To evaluate the effects of prostate-specific antigen（PSA） and free to total PSA（F/T） test for diagnosing prostate cancer. Methods Articles related to diagnosis of prostate cancer by PSA and F/T,published from January 1990 to March 2005,were retrievaled in the databanks such as MEDLINE,CBMdisc,CMCC,CNKI and VIP.Related journals were searched manually.Meta-analysis was performed by SROC curve recommended by Diagnostic and Screening Group of the Cochrane Collaboration Web with the parameters such as sensitivity,specificity,accuracy and SROC AUC（areas under curves）. Results In total 10 studies including 2 256 patients met the inclusion criteria.The sensitivity of PSA〉4 ng/ml or PSA〉10 ng/ml or the ratio of F/T〈0.15 as threshold for the diagnosis of prostate cancer were 90%,65% and 69%.The specificity were 58%,87% and 82%.The SROC AUC of PSA〉4 ng/ml or PSA〉10 ng/ml or the ratio of F/T〈0.15 as threshold were 80%,85% and 86%,respectively. Conclusions F/T〈0.15 is a slightly more accurate method in early diagnosis of prostate cancer in Chinese.