摘要
目的系统评价不同肝癌筛查技术的准确性,为人群筛查和早期诊断提供依据。方法计算机检索Pub Med、The Cochrane Library、EMbase、Web of Science、CNKI、Wan Fang Data、CBM和VIP,搜集肝癌筛查的诊断性试验,检索时限均从1980年1月至2017年12月。由2名研究员独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用Meta-Disc1.4软件行Meta分析。结果最终纳入54个研究,包括47 728例患者。Meta结果显示,单独血清甲胎蛋白筛查(AFP)不同截断值(20 ng/m L、200 ng/m L和400 ng/m L)筛查肝癌的Sen_(合并)分别为0.71[95%CI(0.70,0.72)]、0.57[95%CI(0.56,0.59)]和0.43[95%CI(0.41,0.45)],Spe_(合并)分别为0.92[95%CI(0.92,0.93)]、0.95[95%CI(0.94,0.96)]和0.95[95%CI(0.94,0.96),+LR_(合并)分别为5.65[95%CI(4.37,7.30)]、13.24[95%CI(4.25,41.22)]和11.39[95%CI(4.01,32.35)],–LR_(合并)分别为0.35[95%CI(0.31,0.39)]、0.38[95%CI(0.29,0.52)]和0.49[95%CI(0.39,0.62)],DOR分别为17.23[95%CI(12.26,24.20)]、33.79[95%CI(12.65,90.24)]和24.41[95%CI(9.23,64.53)];单独肝脏超声筛查肝癌的Sen_(合并)、Spe_(合并)、+LR_(合并)、–LR_(合并)、DOR分别为0.65[95%CI(0.62,0.69)]、0.97[95%CI(0.97,0.97)]、16.48[95%CI(9.55,28.42)]、0.27[95%CI(0.18,0.42)]和64.54[95%CI(30.16,138.11)];AFP-20联合超声筛查肝癌的Sen_(合并)、Spe_(合并)、+LR_(合并)、–LR_(合并)、DOR分别为0.96[95%CI(0.94,0.98)]、0.96[95%CI(0.96,0.96)]、10.76[95%CI(2.62,44.27)]、0.07[95%CI(0.02,0.22)]和160.59[95%CI(31.61,816.03)]。结论单独血清甲胎蛋白筛查以20 ng/m L为阈值时诊断价值最佳,其联合超声检查的筛查方案,可大幅提高诊断敏感度,适用于高危人群筛查。
Objectives To evaluate the accuracy of liver cancer screening techniques to inform screening intervention and early diagnosis. Methods We searched Pub Med, The Cochrane Library, EMbase, Web of Science,CNKI, Wan Fang Data, CBM, VIP databases to collect relevant diagnostic accuracy studies of screening technologies for liver cancer from January 1980 to December 2017. Two reviewers independently screened the literature, extracted the data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Meta-Disc 1.4 software.Results A total of 54 publications with 47 728 individuals were included. In terms of pooled sensitivity from the metaanalysis, it was estimated as 0.71(95%CI 0.70 to 0.72), 0.57(95%CI 0.56 to 0.59) and 0.43(95%CI 0.41 to 0.45); the pooled specificity was estimated as 0.92(95%CI 0.92 to 0.93), 0.95(95%CI 0.94 to 0.96) and 0.95(95%CI 0.94 to 0.96); the pooled positive likelihood ratio was 5.65(95%CI 4.37 to 7.30), 13.24(95%CI 4.25 to 41.22) and 11.39(95%CI 4.01 to 32.35); the pooled negative likelihood ratio was 0.35(95%CI 0.31 to 0.39), 0.38(95%CI 0.29 to 0.52) and 0.49(95%CI 0.39 to 0.62);the diagnosis odds ratio was 17.23(95%CI 12.26 to 24.20), 33.79(95%CI 12.65 to 90.24) and 24.41(95%CI 9.23 to 64.53)for AFP alone with cut-off of 20, 200 and 400 ng/mL, respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.65(95%CI 0.62 to 0.69), 0.97(95%CI 0.97 to 0.97), 16.48(95%CI 9.55 to 28.42), 0.27(95%CI 0.18 to 0.42) and 64.54(95%CI 30.16 to 138.11) for ultrasound examination alone. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.96(95%CI0.94 to 0.98), 0.96(95%CI 0.96 to 0.96), 10.76(95%CI 2.62 to 44.27), 0.07(95%CI 0.02 to 0.22) and 160.59(95%CI 31.61 to816.03) for the combined strategy. Conclusion For liver cancer screening technologies, the overall accuracy of serum AFP test alone is the optimum at cut-off of 20 ng/mL, and the sensitivity increased substantially when combined with ultrasound examination.
作者
严永锋
王宇婷
朱陈
朱健
樊春笋
白方舟
陆健泉
杜灵彬
任建松
赵建军
陈陶阳
曲春枫
石菊芳
YAN Yongfeng1, WANG Yuting2, ZHU Chen3, ZHU Jian1, FAN Chunsun1, BAI Fangzhou4, LU Jianquan1, DU Lingbin3, REN Jiansong4, ZHAO Jianjun4,5, CHEN Taoyang1, QU Chunfeng2, SHI Jufang4(1. Department of Etiology, Qidong People's Hospital and Qidong Liver Cancer Institute, Qidong, Jiangsu, 226200, P.R.China; 2. State Key Laboratory of Molecular Oncology/Department of Immunology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100021, P.R.China; 3. Zhejiang Provincial Office for Cancer Prevention, Zhejiang Cancer Center, Zhejiang Cancer Hospital, Hangzhou, 310022, P.R. China; 4. Office of Cancer Screening, National Cancer Center/Cancer Hospital, CAMS & PUMC, Beijing, 100021, P.R.China; 5. Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, CAMS & PUMC, Beijing, 100021, P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2018年第5期418-427,共10页
Chinese Journal of Evidence-based Medicine
基金
国家"十三五"传染病重大专项项目(编号:2017ZX10201201-006-002
2017ZX10201201-006-003
2017ZX10201201-008-002)
十三五国家重点研发计划项目(编号:2017YFC0908103)
南通市市级科技计划项目(编号:YYZ17041
YYZ17055)
关键词
肝癌
甲胎蛋白
超声
筛查
诊断性试验
META分析
Liver cancer
Alpha-Fetoprotein
Ultrasonography
Screening
Diagnostic test
Meta-analysis