血清CEA、CA19-9和CA72-4检测在胃癌机会性筛查中应用价值的荟萃分析

Value of serum CEA,CA19-9 and CA72-4 detection in opportunistic screening for gastric cancer:a meta-analysis

目的基于荟萃分析评价血清癌胚抗原(CEA)、糖类抗原(CA)19-9、CA72-4检测在胃癌机会性筛查中的应用价值。方法从中国知网、万方、重庆维普、PubMed、Cochrane和Embase数据库进行电子检索,文献发表时间为建库到2023年5月,收集CEA、CA19-9和CA72-4筛查及诊断胃癌的文献。采用诊断准确性研究的质量评价工具(QUADAS-2)和Stata17.0软件对文献进行质量评价和荟萃分析。结果共23篇文献入选,其中胃癌患者组5287例,对照组6129例。CEA、CA19-9、CA72-4在胃癌诊断(筛查)中合并灵敏度和特异度分别为0.42、0.45、0.53和0.94、0.91、0.95。综合受试者工作特征(sROC)曲线下面积(area under curve,AUC)分别为0.82、0.77、0.87。3种标志物联合(并联)灵敏度升高为0.66(95%CI:0.54~0.76),特异度下降为0.85(95%CI:0.81~0.89),AUC基本不变为0.86(95%CI:0.83~0.89)。结论血清CEA、CA19-9和CA72-4作为胃癌筛查及健康体检的生物标志物,其灵敏度都比较低,应用效果有限。

Objective To evaluate the application value of serum carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9 and CA72-4 detection in the opportunistic screening(healthy physical examination)of gastric cancer based on a meta-analysis.Methods A published literature searching up to May 2023 was performed in databases of CNKI,Wanfang Databases,VIP,PubMed,Cochran and Embase for studies on CEA,CA19-9 and CA72-4 detection and diagnosis of gastric cancer.The Quality Evaluation Tool of Diagnostic Accuracy Studies(QUADAS-2)was used to evaluate the quality of the literature.Stata17.0 statistical software was used for meta-analysis.Results According to the inclusion and exclusion criteria,a total of 23 studies with 5287 gastric cancer patients and 6129 controls were included.The pooled sensitivity and specificity of serum CEA,CA19-9 and CA72-4 as a diagnostic marker for gastric cancer were 0.42,0.45 and 0.52,and 0.94,0.91 and 0.95,respectively.The area under the summary receiver operating characteristic(sROC)curve for discriminating gastric cancer was 0.82,0.77 and 0.87,respectively.The sensitivity of combined(parallel)diagnosis of gastric cancer with the three biomarkers increased to 0.66(95%CI:0.54-0.76),the specificity decreased to 0.85(95%CI:0.81-0.89),and the area under the curve basically remained unchanged at 0.86(95%CI:0.83-0.89).Conclusions Due to poor sensitivity,the application effects of serum CEA,CA19-9 and CA72-4 as biomarkers for gastric cancer screening and physical examination are limited.