RT-PCR技术检测尿液中survivin mRNA对膀胱癌诊断价值的系统评价

The diagnostic value of urine-based survivin mRNA test using reverse transcription-polymerase chain reaction for bladder cancer:a systematic review

背景与目的:Survivin基因逐渐成为肿瘤诊断、判断预后和治疗的靶点。用RT-PCR技术检测尿液中survivin mRNA作为一种无创性手段用于膀胱癌的诊断,国内外相关研究较多,但其结果不一。本研究旨在应用系统评价方法对相关文献进行客观评价,以评估RT-PCR技术检测尿液中survivin mRNA对膀胱癌的诊断价值。方法:以膀胱肿瘤、生存素、逆转录-聚合酶链反应、敏感度、特异度、诊断等为主要检索词检索PubMed、EMBASE、SCI、Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CJFD)、中文科技期刊数据库(CSJD)、中华医学会数字化期刊等数据库,并结合Google Scholar等搜索引擎全面搜集1997年到2009年4月关于RT-PCR检测尿液survivin mRNA诊断膀胱癌的研究。根据QUADAS(quality assessment of diagnostic accuracy studies)质量评价标准评价纳入文献质量,用Meta-Disc软件对结果指标进行分析。结果:最终纳入26个研究,共2416例。Meta分析结果显示,RT-PCR技术检测尿液中survivin mRNA诊断膀胱癌与病理检查相比准确度指标合并敏感度、特异度、阳性似然比、阴性似然比及SROC曲线下面积分别为88%、94%、14.56、0.13、0.9736;巢式RT-PCR技术检测的敏感度、特异度及SROC曲线下面积最高,分别为91%、95%、0.9805;普通RT-PCR技术检测的敏感度和特异度次之,分别为87%和94%;定量RT-PCR技术检测的敏感度为80%,特异度为93%。结论:与病理检查相比,RT-PCR技术检测尿液中survivin mRNA诊断膀胱癌有较高的敏感度和特异度,可作为膀胱镜检查的主要辅助手段之一,用于膀胱癌的筛查及术后监测。

Background and Objective：Survivin has gradually become an important target in diagnosis,prognosis prediction and treatment of tumor. There are many studies on urine-based survivin mRNA test using reverse transcription-polymerase chain reaction （RT-PCR） as a noninvasive examination for bladder cancer. However,its clinical value remains controversial. This study was to evaluate the diagnostic value of urine survivin mRNA detection with RT-PCR for bladder cancer by a systematic review of related studies. Methods：With the search terms such as bladder neoplasm,survivin,RT-PCR,sensitivity,specificity and diagnosis,we systematically searched through PubMed,EMBASE,SCI,Cochrane Library,Chinese Biomedical Literature Database （CBM）,Chinese Scientific Journal Full-Text Database （CSJD）,China Journal Full-Text Database （CJFD）,Chinese Medical Association （CMA） digital periodicals and Google Scholar totally from January 1997 to April 2009 for diagnostic trials with RT-PCR detection of urine survivin mRNA for bladder cancer. The Quality Assessment of Diagnostic Accuracy Studies （QUADAS） items were used to evaluate the quality of the included studies. Meta-disc software was used to calculate outcome indicators. Results：Twenty-six studies,totally 2416 patients,were eligible. Meta-analysis showed that compared with pathologic examination,the summary values of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and summary receiver operating characteristic curve （SROC） of urine-based survivin mRNA test using RT-PCR for bladder cancer were 88%,94%,14.56,0.13 and 0.9736,respectively. Nested RT-PCR got the highest sensitivity,specificity and SROC and the values were 91%,95% and 0.9805,respectively. The sensitivity and specificity of general RT-PCR were the second highest,which were 87% and 94%,respectively. The sensitivity of quantitative RT-PCR was 80% and the specificity was 93%. Conclusions：Comparing with pathologic examination,the sensitivity and specificity of urine-based survivin mRNA test using RT-PCR are relatively high. It can be used as an important adjunct method for cystoscope in early screening and postoperative monitoring of bladder cancer.