血清CEA、CA19-9和CA242检测在中国人群结直肠癌机会性筛查中应用的荟萃分析

Application value of serum CEA,CA19-9 and CA242 in opportunistic screening for colorectal cancer in Chinese population:a meta-analysis

目的应用荟萃分析评价血清癌胚抗原(CEA)、糖类抗原19-9(CA19-9)和CA242检测在结直肠癌机会性筛查中的应用价值。方法检索Pubmed、Embase、Cochrane Library、中国知网、万方和维普数据库从建库至2023年10月关于CEA、CA19-9和CA242检测在结直肠癌筛查中应用的原始研究文献(1205篇),经过筛选共34篇文献纳入研究。采用诊断准确性研究的质量评价工具(QUADAS-2)对文献进行质量评价,Stata17.0统计软件进行荟萃分析,Deek漏斗图检验文献发表偏倚。结果纳入的34篇文献均为病例对照研究,荟萃分析结果显示CEA、CA19-9和CA242单独检测的诊断准确性和灵敏度均较低。综合受试者工作特征(sROC)曲线下面积(AUC)分别为0.62、0.63和0.73,灵敏度分别为0.42、0.27和0.36。CEA、CA19-9和CA242联合检测可明显提高诊断准确性和灵敏度[AUC:0.92(95%CI:0.89~0.94),灵敏度:0.75(95%CI:0.65~0.83)],特异度略有下降[从0.95降至0.90(95%CI:0.87~0.93)]。Deek检验表明无发表偏倚。结论CEA+CA19-9+CA242联合检测可以提高诊断结直肠癌的准确性以及灵敏度,但考虑缺乏体检人群的研究,是否适用于体检人群的筛查尚待进一步研究证实。

Objective To analyze the application value of serum carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9 and CA242 in screening colorectal cancer with a meta-analysis.Methods A literature search was conducted in the databases of Pubmed,Embase,Cochrane,CNKI,Wanfang and VIP to identify studies on applying CEA,CA19-9 and CA242 for detection of colorectal cancer from the establishment of the databases to October 2023.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.Deeks funnel plot was used to analyze publication bias.Results A total of 34 articles of case-control studies met the criteria.Meta-analysis revealed that the diagnostic accuracy and sensitivity of CEA,CA19-9 and CA242 were all low,the area under the curve(AUC)of summary receiver operating characteristic curve was 0.62,0.63 and 0.73,the sensitivity was 0.42,0.27 and 0.36,respectively.The combined detection of CEA+CA19-9+CA242 significantly improved the pooled diagnostic accuracy(AUC:0.92(95%CI:0.89-0.94)and sensitivity:0.75(95%CI:0.65-0.83)),the specificity was mildly reduced(dropped from above 0.95 to 0.90(95%CI 0.87-0.93)).The Deek′s test indicated no publication bias.Conclusions Combined detection of CEA+CA19-9+CA242 can significantly improve the diagnostic accuracy and sensitivity in screening colorectal cancer with a compromised specificity.However,due to the lack of data,whether it can meet the demand for opportunistic screening in the physical examination population needs to be confirmed.