Yan Lin, Zhao Wenhua, Yu Haihua, Wang Yansen, Liu Yuanshui, Xie Chao
From the Department of Oncology and Pneumology (LY, YW), Shandong Jiaotong Hospital; Department of Oncology (WZ, YL) ; Department of Gastrointestinal Surgery (HY), Shandong Provincial Qianfoshan Hospital, Shandong University; and The Third Department of Internal Medicine (CX), Shandong Tumor Hospital, Jinan, Shandong, China.
Medicine (Baltimore). 2016 Mar;95(9):e2738. doi: 10.1097/MD.0000000000002738.
Colorectal cancer (CRC) has been defined as a common malignancy due to its prevailing incidence in both males and females. Recently, the intrinsic value of microRNAs (miRNAs) with respect to early cancer diagnosis has been contentious as the diagnostic accuracy of miRNAs significantly varied across different studies. As a result of this, this pioneer meta-analysis was proposed to address this issue. Qualified studies were obtained through electronic systematical searching in Medline, Embase, and PubMed. On the basis of the random-effects model, we calculated the pooled sensitivity (SEN), specificity (SPE), and area under the receiver operating characteristics curve (AUC) to assess the diagnostic accuracy of miRNAs. Subgroup analysis and meta-regression were implemented to determine how different confounding factors affect the overall diagnostic accuracy which were considered important sources of heterogeneity. All the statistical analyses were conducted with R 3.2.1 software. We incorporated 103 studies from 36 articles with a total of 3124 CRC patients and 2579 healthy individuals. MiRNAs have a good performance with the following pooled estimates: SEN = 0.769 (95% CI = 0.733-0.802), SPE = 0.806 (95% CI = 0.781-0.829), AUC = 0.857, and partial AUC = 0.773. As suggested by subgroup analyses and meta-regression, multiple miRNAs appeared to be more favorable than single miRNA (AUC: 0.918 > 0.813, partial AUC: 0.848 > 0.701, sensitivity = 0.853 > 0.718, specificity = 0.860 > 0.772). Compared with samples of plasma, blood, tissue, and feces, miRNA obtained from serum samples were more powerful for detecting CRC particularly in Asian. Our study provided exclusive evidence that multiple miRNAs extracted from serum samples had superior diagnostic performance over single miRNA for screening CRC. Therefore, this approach that is characterized by high specificity and noninvasive nature may assist in early diagnosis of CRC particularly in Asian.
由于结直肠癌（CRC）在男性和女性中发病率普遍较高，已被定义为一种常见的恶性肿瘤。最近，微小RNA（miRNA）在早期癌症诊断方面的内在价值一直存在争议，因为不同研究中miRNA的诊断准确性差异很大。因此，开展了这项开创性的荟萃分析来解决这个问题。通过在Medline、Embase和PubMed中进行电子系统检索获得合格研究。基于随机效应模型，我们计算了合并敏感度（SEN）、特异度（SPE）和受试者工作特征曲线下面积（AUC），以评估miRNA的诊断准确性。进行亚组分析和荟萃回归，以确定不同混杂因素如何影响总体诊断准确性，这些因素被认为是异质性的重要来源。所有统计分析均使用R 3.2.1软件进行。我们纳入了36篇文章中的103项研究，共有3124例CRC患者和2579名健康个体。miRNA具有良好的性能，合并估计值如下：SEN = 0.769（95%CI = 0.733 - 0.802），SPE = 0.806（95%CI = 0.781 - 0.829），AUC = 0.857，部分AUC = 0.773。亚组分析和荟萃回归表明，多个miRNA似乎比单个miRNA更具优势（AUC：0.918 > 0.813，部分AUC：0.848 > 0.701，敏感度 = 0.853 > 0.718，特异度 = 0.860 > 0.772）。与血浆、血液、组织和粪便样本相比，从血清样本中获得的miRNA在检测CRC方面更有效，尤其是在亚洲人群中。我们的研究提供了独家证据，表明从血清样本中提取的多个miRNA在筛查CRC方面比单个miRNA具有更好的诊断性能。因此，这种具有高特异性和非侵入性特点的方法可能有助于CRC的早期诊断，尤其是在亚洲人群中。
