用于前列腺活检决策的前列腺癌抗原3检测：一项系统评价和荟萃分析

Prostate cancer antigen 3 test for prostate biopsy decision: a systematic review and meta analysis.

作者信息

Luo Yong, Gou Xin, Huang Peng, Mou Chan

机构信息

Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.

Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China? Email:

出版信息

Chin Med J (Engl). 2014;127(9):1768-74.

PMID:24791889

Abstract

BACKGROUND

The specificity for early interventions of prostate-specific antigen (PSA) in prostate cancer (PCa) is not satisfactory. It is likely that prostate cancer antigen 3 (PCA3) can be used to predict biopsy outcomes more accurately than PSA for the early detection of PCa. We systematically reviewed literatures and subsequently performed a meta-analysis.

METHODS

A bibliographic search in the database of Embase, Medline, Web of Science, NCBI, PubMed, CNKI, and those of health technology assessment agencies published before April 2013 was conducted. The key words used were "prostatic neoplasms", "prostate", "'prostate', 'carcinoma' or 'cancer' or 'tumor', or 'PCa,'" and free terms of "upm3", "pca3", "dd3", "aptimapca 3", and "prostate cancer antigen 3". All patients were adults. The intervention was detecting PCA3 in urine samples for PCa diagnosis. We checked the quality based on the QUADAS criteria, collected data, and developed a meta-analysis to synthesize results. Twenty-four studies of diagnostic tests with moderate to high quality were selected.

RESULTS

The sensitivity was between 46.9% and 82.3%; specificity was from 55% to 92%; positive predictive value had a range of 39.0%-86.0%; and the negative predictive value was 61.0%-89.7%. The meta-analysis has heterogeneity between studies. The global sensitivity value was 0.82 (95% CI 0.72-0.90); specificity was 0.962 (95% CI 0.73-0.99); positive likelihood ratio was 2.39 (95% CI 2.10-2.71); negative likelihood ratio was 0.51 (95% CI 0.46-0.86); diagnostic odds ratio was 4.89 (95% CI 3.94-6.06); and AUC in SROC curve was 0.744 1.

CONCLUSION

PCA3 can be used for early diagnosis of PCa and to avoid unnecessary biopsies.

摘要

背景

前列腺特异性抗原（PSA）在前列腺癌（PCa）早期干预中的特异性并不令人满意。前列腺癌抗原3（PCA3）可能比PSA更准确地预测活检结果，用于PCa的早期检测。我们系统地回顾了文献并随后进行了荟萃分析。

方法

在Embase、Medline、Web of Science、NCBI、PubMed、CNKI数据库以及2013年4月之前发布的卫生技术评估机构的数据库中进行文献检索。使用的关键词为“前列腺肿瘤”“前列腺”“‘前列腺’‘癌’或‘癌症’或‘肿瘤’或‘PCa’”以及“upm3”“pca3”“dd3”“aptimapca 3”和“前列腺癌抗原3”的自由词。所有患者均为成年人。干预措施是检测尿液样本中的PCA3用于PCa诊断。我们根据QUADAS标准检查质量，收集数据，并进行荟萃分析以综合结果。选择了24项质量中等至高的诊断试验研究。

结果

敏感性在46.9%至82.3%之间；特异性为55%至92%；阳性预测值范围为39.0% - 86.0%；阴性预测值为61.0% - 89.7%。荟萃分析显示各研究之间存在异质性。总体敏感性值为0.82（95%可信区间0.72 - 0.90）；特异性为0.962（95%可信区间0.73 - 0.99）；阳性似然比为2.39（95%可信区间2.10 - 2.71）；阴性似然比为0.51（95%可信区间0.46 - 0.86）；诊断比值比为4.89（95%可信区间3.94 - 6.06）；SROC曲线中的AUC为0.744 1。