Su Si-Biao, Qin Shan-Yu, Chen Wen, Luo Wei, Jiang Hai-Xing
Si-Biao Su, Shan-Yu Qin, Wei Luo, Hai-Xing Jiang, Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
World J Gastroenterol. 2015 Apr 14;21(14):4323-33. doi: 10.3748/wjg.v21.i14.4323.
To evaluate the utility of carbohydrate antigen 19-9 (CA19-9) for differential diagnosis of pancreatic carcinoma and chronic pancreatitis.
We searched the literature for studies reporting the sensitivity, specificity, and other accuracy measures of serum CA19-9 levels for differentiating pancreatic carcinoma and chronic pancreatitis. Pooled analysis was performed using random-effects models, and receiver operating characteristic (ROC) curves were generated. Study quality was assessed using Standards for Reporting Diagnostic Accuracy and Quality Assessment for Studies of Diagnostic Accuracy tools.
A total of 34 studies involving 3125 patients with pancreatic carcinoma and 2061 patients with chronic pancreatitis were included. Pooled analysis of the ability of CA19-9 level to differentiate pancreatic carcinoma and chronic pancreatitis showed the following effect estimates: sensitivity, 0.81 (95%CI: 0.80-0.83); specificity, 0.81 (95%CI: 0.79-0.82); positive likelihood ratio, 4.08 (95%CI: 3.39-4.91); negative likelihood ratio, 0.24 (95%CI: 0.21-0.28); and diagnostic odds ratio, 19.31 (95%CI: 14.40-25.90). The area under the ROC curve was 0.88. No significant publication bias was detected.
Elevated CA19-9 by itself is insufficient for differentiating pancreatic carcinoma and chronic pancreatitis, however, it increases suspicion of pancreatic carcinoma and may complement other clinical findings to improve diagnostic accuracy.
评估糖类抗原19-9（CA19-9）在胰腺癌与慢性胰腺炎鉴别诊断中的应用价值。
我们检索了相关文献，以查找报告血清CA19-9水平用于鉴别胰腺癌和慢性胰腺炎的敏感性、特异性及其他准确性指标的研究。采用随机效应模型进行汇总分析，并绘制受试者工作特征（ROC）曲线。使用《诊断准确性报告标准》和《诊断准确性研究质量评估工具》对研究质量进行评估。
共纳入34项研究，涉及3125例胰腺癌患者和2061例慢性胰腺炎患者。对CA19-9水平鉴别胰腺癌和慢性胰腺炎能力的汇总分析显示以下效应估计值：敏感性为0.81（95%CI：0.80 - 0.83）；特异性为0.81（95%CI：0.79 - 0.82）；阳性似然比为4.08（95%CI：3.39 - 4.91）；阴性似然比为0.24（95%CI：0.21 - 0.28）；诊断比值比为19.31（95%CI：14.40 - 25.90）。ROC曲线下面积为0.88。未检测到显著的发表偏倚。
单纯CA19-9升高不足以鉴别胰腺癌和慢性胰腺炎，然而，它会增加对胰腺癌的怀疑，并可能补充其他临床发现以提高诊断准确性。
