Yang Hua, Xia Bing-Qing, Jiang Bo, Wang Guozhen, Yang Yi-Peng, Chen Hao, Li Bing-Sheng, Xu An-Gao, Huang Yun-Bo, Wang Xin-Ying
Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Can J Gastroenterol. 2013 Aug;27(8):467-75. doi: 10.1155/2013/258030.
The diagnostic value of stool DNA (sDNA) testing for colorectal neoplasms remains controversial. To compensate for the lack of large-scale unbiased population studies, a meta-analysis was performed to evaluate the diagnostic value of sDNA testing for multiple markers of colorectal cancer (CRC) and advanced adenoma.
The PubMed, Science Direct, Biosis Review, Cochrane Library and Embase databases were systematically searched in January 2012 without time restriction. Meta-analysis was performed using a random-effects model using sensitivity, specificity, diagnostic OR (DOR), summary ROC curves, area under the curve (AUC), and 95% CIs as effect measures. Heterogeneity was measured using the χ(2) test and Q statistic; subgroup analysis was also conducted.
A total of 20 studies comprising 5876 individuals were eligible. There was no heterogeneity for CRC, but adenoma and advanced adenoma harboured considerable heterogeneity influenced by risk classification and various detection markers. Stratification analysis according to risk classification showed that multiple markers had a high DOR for the high-risk subgroups of both CRC (sensitivity 0.759 [95% CI 0.711 to 0.804]; specificity 0.883 [95% CI 0.846 to 0.913]; AUC 0.906) and advanced adenoma (sensitivity 0.683 [95% CI 0.584 to 0.771]; specificity 0.918 [95% CI 0.866 to 0.954]; AUC 0.946) but not for the average-risk subgroups of either. In the methylation subgroup, sDNA testing had significantly higher DOR for CRC (sensitivity 0.753 [95% CI 0.685 to 0.812]; specificity 0.913 [95% CI 0.860 to 0.950]; AUC 0.918) and advanced adenoma (sensitivity 0.623 [95% CI 0.527 to 0.712]; specificity 0.926 [95% CI 0.882 to 0.958]; AUC 0.910) compared with the mutation subgroup. There was no significant heterogeneity among studies for subgroup analysis.
sDNA testing for multiple markers had strong diagnostic significance for CRC and advanced adenoma in high-risk subjects. Methylation makers had more diagnostic value than mutation markers.
粪便DNA（sDNA）检测对结直肠肿瘤的诊断价值仍存在争议。为弥补缺乏大规模无偏倚人群研究的不足，进行了一项荟萃分析，以评估sDNA检测对结直肠癌（CRC）和进展性腺瘤多种标志物的诊断价值。
于2012年1月对PubMed、Science Direct、Biosis Review、Cochrane图书馆和Embase数据库进行系统检索，无时间限制。采用随机效应模型进行荟萃分析，以敏感性、特异性、诊断比值比（DOR）、汇总ROC曲线、曲线下面积（AUC）和95%置信区间作为效应量。采用χ(2)检验和Q统计量测量异质性；还进行了亚组分析。
共有20项研究，包括5876名个体符合条件。CRC不存在异质性，但腺瘤和进展性腺瘤存在相当大的异质性，受风险分类和各种检测标志物影响。根据风险分类进行的分层分析表明，多种标志物对CRC（敏感性0.759[95%CI 0.711至0.804]；特异性0.883[95%CI 0.846至0.913]；AUC 0.906）和进展性腺瘤（敏感性0.683[95%CI 0.584至0.771]；特异性0.918[95%CI 0.866至0.954]；AUC 0.946）的高风险亚组具有较高的DOR，但对两者的平均风险亚组则不然。在甲基化亚组中，与突变亚组相比，sDNA检测对CRC（敏感性0.753[95%CI 0.685至0.812]；特异性0.913[95%CI 0.860至0.950]；AUC 0.918）和进展性腺瘤（敏感性0.623[95%CI 0.527至0.712]；特异性0.926[95%CI 0.882至0.958]；AUC 0.910）具有显著更高的DOR。亚组分析的研究之间不存在显著异质性。
多种标志物的sDNA检测对高危受试者的CRC和进展性腺瘤具有较强的诊断意义。甲基化标志物比突变标志物具有更高的诊断价值。
