Wu Qiang, Li Min, Zhang Shu, Chen Lu, Gu Xingting, Xu Feng
Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.
Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.
Exp Ther Med. 2015 Jan;9(1):232-238. doi: 10.3892/etm.2014.2039. Epub 2014 Oct 30.
Malignant pleural effusion (MPE) is one of the most common pleura-associated conditions observed in clinical practice. The development of MPE usually defines advanced cancer with a poor prognosis. Carbohydrate antigen 15-3 (CA 15-3), as an effective pleural fluid biomarker, has been an object of ongoing research in the detection of MPE. The aim of this meta-analysis was to establish the overall diagnostic accuracy of the measurement of pleural CA 15-3 for diagnosing MPE. The databases Medline (using PubMed as the search engine), Embase, Ovid, Web of Science and Cochrane database (up to December 2013) were searched to identify relevant studies. No lower date limit was applied. All literature published in English was reviewed. Sensitivity, specificity, likelihood ratio and diagnostic odds ratio (DOR) were pooled using a random-effect model. Summary receiver operating characteristic (SROC) curve analysis was conducted to evaluate the overall diagnostic value. The methodological quality was assessed in line with the Quality Assessment for Studies of Diagnostic Accuracy statement. Twenty-one studies with a total of 2,861 cases were included in present meta-analysis. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and DOR of CA 15-3 in the diagnosis of MPE were 0.58 [95% confidence interval (CI), 0.56-0.61], 0.91 (95% CI, 0.90-0.93), 8.93 (95% CI, 4.45-17.93), 0.46 (95% CI, 0.37-0.56) and 24.89 (95% CI, 10.39-59.63), respectively. In addition, the area under the curve (AUC) was 0.84. In conclusion, due to the significantly high specificity of pleural CA 15-3 in detecting MPE, it may play a pivotal role in screening to identify patients who may benefit from further invasive pathologic examination, particularly in those presenting clinical manifestations of MPE but with negative cytological findings of the pleural fluid. However, ruling out MPE by testing CA15-3 alone is not recommended due to its limited sensitivity, and it is recommended that the results of CA15-3 assays are interpreted in parallel with conventional test results and other clinical findings.
恶性胸腔积液（MPE）是临床实践中最常见的胸膜相关病症之一。MPE的出现通常意味着癌症已发展至晚期，预后较差。糖类抗原15-3（CA 15-3）作为一种有效的胸水生物标志物，一直是MPE检测领域持续研究的对象。本荟萃分析的目的是确定检测胸腔CA 15-3对诊断MPE的总体诊断准确性。检索了Medline数据库（使用PubMed作为搜索引擎）、Embase数据库、Ovid数据库、Web of Science数据库和Cochrane数据库（截至2013年12月）以识别相关研究。未设定下限日期。对所有英文发表的文献进行了综述。使用随机效应模型汇总敏感性、特异性、似然比和诊断比值比（DOR）。进行汇总受试者工作特征（SROC）曲线分析以评估总体诊断价值。根据《诊断准确性研究质量评估声明》评估方法学质量。本荟萃分析纳入了21项研究，共2861例病例。CA 15-3诊断MPE的敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）和DOR分别为0.58 [95%置信区间（CI），0.56 - 0.61]、0.91（95% CI，0.90 - 0.93）、8.93（95% CI，4.45 - 17.93）、0.46（95% CI，0.37 - 0.５6）和24.89（95% CI，10.39 - 59.63）。此外，曲线下面积（AUC）为0.84。总之，由于胸腔CA 15-3检测MPE具有显著高的特异性，它可能在筛查中发挥关键作用，以识别可能从进一步侵入性病理检查中获益的患者，特别是那些有MPE临床表现但胸水细胞学检查结果为阴性的患者。然而，由于其敏感性有限，不建议仅通过检测CA15-3来排除MPE，建议将CA15-3检测结果与传统检测结果及其他临床发现一并解读。
