中国循证医学杂志

中国循证医学杂志

间皮素在卵巢癌诊断中价值的 Meta 分析

查看全文

目的 系统评价血清标志物间皮素在卵巢癌中的诊断价值。 方法 计算机检索 PubMed、Web of Science、The Cochrane Library、CBM、CNKI 和 WanFang Data 数据库,搜集间皮素诊断卵巢癌的诊断性试验,检索时限从建库至 2016 年 10 月。由 2 位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 Meta-DiSc 1.4、Stata 12 和 RevMan 5.2 软件进行统计分析,计算其合并敏感度(Sen合并)、特异性(Spe合并)、诊断比值比(DOR),绘制汇总受试者工作特征(SROC)曲线并计算曲线下面积(AUC)。 结果 共纳入 17 个研究,包括 2 052 例患者。Meta 分析结果显示:间皮素诊断卵巢癌的 Sen合并、Spe合并、DOR 分别为 0.63[95%(0.60,0.67)]、0.92[95%(0.90,0.93)]、26.62[95%(14.96,47.38)],AUC 和 Q 指数分别为 0.915 1 和 0.847 8。 结论 当前证据显示,间皮素诊断卵巢癌特异性较高而敏感度较低,不能单独作为生物标志物用于卵巢癌的检测,应与其它标志物进行联合检测。

Objective To estimate the diagnostic value of mesothelin in ovarian cancer. Methods PubMed, The Cochrane Library, CBM, CNKI and WanFang Data databases were searched from inception to October 2016 to collect relevant diagnostic accuracy studies of mesothelin in ovarian cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was performed using Meta-Disc 1.4, Stata 12.0 and RevMan 5.2 softwares. The pooled sensitivity, specificity and diagnostic odds ratio were calculated, the summary receiver operating characteristic curve (SROC) was drawn and the area under the curve (AUC) was calculated. Results Seventeen studies involving 2 052 patients were included. The pooled sensitivity, specificity, DOR were 0.63 (95%CI 0.60 to 0.67), 0.92 (95%CI 0.90 to 0.93) and 26.62 (95%CI 14.96 to 47.38), respectively. The AUC and Q index were 0.915 1 and 0.847 8, respectively. Conclusion The current evidence indicates that mesothelin has high specificity and low sensitivity, which can’t be used alone as a biomarker for the detection of ovarian cancer, but should be combined with other biomarkers.

关键词: 卵巢癌; 间皮素; 生物标志物; 诊断; Meta 分析

Key words: Ovarian cancer; Mesothelin; Biomarkers; Diagonosis; Meta-analysis

引用本文: 曲波, 王海琳, 马守叶. 间皮素在卵巢癌诊断中价值的 Meta 分析. 中国循证医学杂志, 2017, 17(11): 1269-1275. doi: 10.7507/1672-2531.201611109 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Jemal A, Siegel R, Ward E, et al. Cancer statistics. CA Cancer J Clin, 2009, 59(4): 225-249.
2. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin, 2013, 63(1): 11-30.
3. Köbel M, Kalloger SE, Boyd N, et al. Ovarian carcinoma subtypes are different diseases: implications for biomarker studies. PLoS Med, 2008, 5(12): e232.
4. Chang K, Pastan I. Molecular cloning of mesothelin, adifferentiation antigen present on mesothelium, mesothelio-mas, and ovarian cancers. Proc Natl Acad Sci USA, 1996, 93(1): 136-140.
5. Huang CY, Cheng WF, Lee CN, et al. Serum mesothelinin epithelial ovarian carcinoma: a new screening marker and prognostic factor. Anticancer Res, 2006, 26(6C): 4721-4728.
6. 尹森林, 刘雪梅, 何林, 等. 对系统评价/Meta 分析报告规范的系统评价. 中国循证医学杂志, 2011, 11(8): 971-977
7. Abdel-Azeez HA, Labib HA, Sharaf SM, et al. HE4 and mesothelin: novel biomarkers of ovarian carcinoma in patients with pelvic masses. Asian Pac J Cancer Prev, 2010, 1(1): 111-116.
8. Bandiera E, Zanotti L, Fabricio AS, et al. Cancer antigen 125, human epididymis 4, kallikrein 6, osteopontin and soluble mesothelinrelated peptide immunocomplexed with immunoglobulin M in epithelial ovarian cancer diagnosis. Clin Chem Lab Med, 2013, 51(9): 1815-1824.
9. Hassan R, Remaley AT, Sampson ML, et al. Detection and quantization of serum mesothelin, a tumor marker for patients with mesothelioma and ovarian cancer. Clin Cancer Res, 2006, 12(2): 447-453.
10. Ho M, Hassan R, Zhang J, et al. Humoral immune response to mesothelin in mesothelioma and ovarian cancer patients. Clin Cancer Res, 2005, 11(10): 3814-3820.
11. Ibrahim M, Bahaa A, Ibrahim A, et al. Evaluation of serum mesothelin in malignant and benign ovarian masses. Arch Gynecol Obstet, 2014, 290(1): 107-113.
12. McIntosh MW, Drescher C, Karlan B, et al. Combining CA 125 and SMR serum markers for diagnosis and early detection of ovarian carcinoma. Gynecol Oncol, 2004, 95(1): 9-15.
13. Moraes DRPL. Concentration of serum markers and presence of specific symptoms in women with or without adnexal masses. Biblioteca Digital Da Unicamp, 2012.
14. Qiao N, Li H. The value of mesothelin in the diagnosis and follow-up of surgically treated ovarian cancer. Eur J Gynaecol Oncol, 2013, 34(2): 163-165.
15. Scholler N, Fu N, Yang Y, et al. Soluble member(s) of the mesothelin/megakaryocyte potentiating factor family are detectable in sera from patients with ovarian carcinoma. Proc Natl Acad Sci USA, 1999, 96(20): 11531-11536.
16. Shah CA, Lowe KA, Paley P, et al. Influence of ovarian cancer risk status on the diagnostic performance of the serum biomarkers mesothelin, HE4, and CA125. Cancer Epidemiol Biomarkers Prev, 2009, 18(5): 1365-1372.
17. Shah CA, Lowe KA, Paley P, et al. Influence of ovarian cancer risk status on the diagnostic performance of the serum biomarkers mesothelin, HE4, and CAL25. Cancer Epidemiol Biomarkers Prev, 2009, 18(5): 1365-1372.
18. Wu X, Li D, Liu L, et al. Serum soluble mesothelin-related peptide (SMRP): a potential diagnostic and monitoring marker for epithelial ovarian cancer. Arch Gynecol Obstet, 2014, 289(6): 1309-1314.
19. 梁艳, 张映艳. 上皮性卵巢癌血清 SMRP、Dc R3 和 CAL25 的表达及临床意义. 实验研究, 2012, 134(26): 1672-5654.
20. 石榴花, 任传路, 丁磊, 等. 联合检测血清 HE4、SMRP、CEA 与 CAL25 在卵巢癌诊断中的应用价值研究. 检验医学与临床, 2016, 13(8): 1068-1070.
21. 苑中甫, 黄伟娟, 樊素珍. 间皮素与血清 CAL25 联合检测上皮性卵巢癌的临床价值. 中国实用妇科与产科杂志, 2011, 27(2): 131-133.
22. 马娟文, 朱天垣, 谢秀英, 等. 可溶性问皮素相关蛋白和癌抗原 125 联合检测在卵巢癌诊断中的价值. 中国医师进修杂志, 2011, 34(27): 50-51.
23. 高雁荣, 黄伟娟. 血清 Mesothelin 和 CAL25 联合检测在上皮性卵巢癌诊断中的意义. 妇科肿瘤, 2012, 20(1): 138-140.
24. Moore RG, McMeekin DS, Brown AK, et al. A novel multiple marker bioassay utilizing HE4 and CA 125 for the prediction of ovarian cancer in patients with a pelvic mass. Gynecol Oncol, 2009, 12(1): 40-46.
25. Gubbels JA, Belisle J, Onda M, et al. Mesothelin-MUC16 binding is a high affinity, N-glycan dependent interaction that facilitates peritoneal metastasis of ovarian tumors. Mol Cancer, 2006, 5(1): 50.
26. Moore RG, Brown AK, Miller MC, et al. The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass. Gynecol Oncol, 2008, 108(2): 402-408.
27. Swets JA. Measuring the accuracy of diagnostic systems. Science, 1988, 240(4857): 1285-1293.