血清CEA、CA153和CA125检测在中国人群乳腺癌机会性筛查中应用的荟萃分析

Meta-analysis of the value of serum CEA,CA153,and CA125 tests in opportunistic screening for breast cancer in Chinese population

目的通过荟萃分析评价癌胚抗原(CEA)、糖类抗原153(CA153)和CA125在中国人群乳腺癌机会性筛查中的应用价值。方法在中国知网数据库、万方数据库、维普中文科技期刊全文数据库、PubMed、Embase、Cochrane Library中检索从建库至2023年5月的公开发表文献。采用诊断性试验质量评价工具QUADAS-2量表进行质量评价。采用Stata 17.0和RevMan5.4进行统计分析。结果纳入21项研究,研究对象共4583例。在乳腺癌诊断中,单独使用3种标志物的灵敏度均<0.50,特异度均>0.95;CEA的灵敏度为0.28(95%CI:0.23~0.33),特异度为0.98(95%CI:0.94~0.99);CA153的灵敏度为0.48(95%CI:0.41~0.55),特异度为0.96(95%CI:0.94~0.98);CA125的灵敏度为0.31(95%CI:0.24~0.39),特异度为0.97(95%CI:0.94~0.98);三者联合检测的灵敏度为0.76(95%CI:0.69~0.81),特异度为0.93(95%CI:0.91~0.94),综合ROC曲线下面积为0.94(95%CI:0.91~0.95)。结论CEA、CA125、CA153联合检测可以在一定程度上提高对乳腺癌的诊断效果,但在筛查人群中应用的证据不足。

Objective To evaluate the value of serum carcinoembryonic antigen(CEA),glycan antigen 153(CA153)and CA125 tests in opportunistic screening of breast cancer in a Chinese population with meta-analysis.Methods The published literatures of opportunistic screening of breast cancer was searched in the databases of China Knowledge Network database,Wanfang database,WIP Chinese Science and Technology Journal Full Text Database,PubMed,Embase,and Cochrane Library were retrieved from the establishment of the databases to May 2023.The Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)scale was used for quality assessment.The software of Stata 17.0 and RevMan were used for data analysis.Results A total of 21 studies with a total of 4583 cases were included.In diagnosis of breast cancer,the sensitivity with CEA was 0.28(95%CI:0.23-0.33),and the specificity was 0.98(95%CI:0.94-0.99);the sensitivity with CA153 was 0.48(95%CI:0.41-0.55)and the specificity was 0.96(95%CI:0.94-0.98);the sensitivity with CA125 was 0.31(95%CI:0.24-0.39)and specificity was 0.97(95%CI:0.94-0.98);the sensitivity of the combined test for the three was 0.76(95%CI:0.69-0.81),the specificity was 0.93(95%CI:0.91-0.94),and the area under the summary receiver operating characteristic(SROC)curve was 0.94(95%CI:0.91-0.95).Conclusion The combination of serum CEA,CA125,and CA153 tests can improve the diagnostic accuracy of breast cancer to a certain extent,but there is insufficient evidence for its application in opportunistic breast cancer screening in population.