国内癌胚抗原检测诊断非小细胞肺癌的系统评价

CEA for the Diagnosis of NSCLC in Chinese Patients: A Systematic Review

目的系统评价国内癌胚抗原(CEA)检测对非小细胞肺癌(NSCLC)的诊断价值。方法计算机检索CBM(1978～2009)和CNKI(1994～2009),以获取国内检测NSCLC血清CEA的诊断性试验研究。由两名评价员按纳入排除标准独立选择文献、用四格表提取数据和应用诊断性试验的6条质量评价标准评价研究质量后,采用Meta Disc 1.0软件进行Meta分析,并用RevMan 4.0软件绘制森林图和SROC曲线。结果共检索到相关文献84篇,最终纳入11个研究,共925例受试者,其中经"金标准"确诊861例。Meta分析结果显示,各组间存在异质性(P=0.0004,I2=69.1%),采用随机效应模型进行合并,SEN合并=0.542,SPE合并=0.896。按不同检测方法和癌症分类进行亚组分析。采用电化学检测的5个研究间无统计学异质性(P=0.376,I2=5.4%),SEN合并=0.500,SPE合并=0.877,SROC曲线下面积=0.7483。检测肺鳞癌患者的研究间无统计学异质性(P=0.955,I2=0.00%),SEN合并=0.296,SPE合并=0.908,SROC曲线下面积=0.7620;检测肺腺癌患者的研究间异质性较小(P=0.186,I2=37.6%),SEN合并=0.632,SPE合并=0.908,SROC曲线下面积=0.9002。结论血清CEA对NSCLC总体诊断敏感性较低,特异性较高,对腺诊断有效性优于鳞癌。血清CEA对诊断NSCLC有一定参考价值。但国内检测NSCLC CEA的诊断性试验文献质量不高,上述结果需更多高质量研究结果予以证实。

Objective To Evaluation of Accuracy and Quality of Diagnostic Test of CEA for the Diagnosis of NSCLC in Chinese Patients.Methods We searched Chinese Biological Medicine Database（CBM,1978 to 2009） and China National Knowledge Infrastructure（CNKI,1994 to 2009）.Diagnostic tests of CEA for the diagnosis of NSCLC were included.Data were extracted,and the quality of included studies was evaluated according to the six criteria of diagnostic tests.The heterogeneity test and The Summary Receiver Operating Characteristic（SROC） curve and meta-analyses were performed by MetaDisc.Results A total of 84 relevant articles were retrieved and 11 were included in our review.Eleven studies involving 925 patients（861 NSCLC patients,all diagnosed by the gold standard） were included.Meta-analyses showed that the heterogeneity among studies was high（P=0.000 2,I2=69.1%）,the pooled sensitivity was 0.542 and the pooled specificity was 0.869.Subgroup analyses indicated that 5 of the studies which used the ECLIA（P=0.376,I2=5.4%,AUC= 0.748 3） and 4 of the studies which lung adenocarcinoma（P=0.186,I2=37.6%,AUC=0.900 2） and 4 of the studies which lung squamous cell carcinoma（P=0.955,I2=0.00%,AUC=0.762 0） had no heterogeneity.serum CEA is low sensitive and high specific on the diagnosis of NSCLC.The sensitivity and diagnostic accuracy rate of CEA were higher in adenocarcionoma than squamous cell cance.Conclusion CEA could be regarded as one of the reference tests in patients with NSCLC,Serum CEA is more sensitive and specific than lung squamous cell carcinoma on lung adenocarcinoma.but more high quality trials are required.