Meng Qingcai, Shi Si, Liang Chen, Liang Dingkong, Xu Wenyan, Ji Shunrong, Zhang Bo, Ni Quanxing, Xu Jin, Yu Xianjun
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center.
Department of Oncology, Shanghai Medical College.
Onco Targets Ther. 2017 Sep 15;10:4591-4598. doi: 10.2147/OTT.S145708. eCollection 2017.
Carcinoembryonic antigen (CEA) is one of the most widely used tumor markers and is increased in 30%-60% of patients with pancreatic cancer. Although carbohydrate antigen 19-9 (CA19-9) is the most important serum biomarker in pancreatic cancer, the diagnostic and prognostic value of CEA is gradually being recognized.
The MEDLINE, EMBASE, and Web of Science databases were searched for related literature published until January 2017. Diagnostic accuracy variables were pooled using the Meta-Disc software. The pooled hazard ratios (HRs) for prognostic data were calculated and analyzed using Stata software.
A total of 3,650 participants enrolled in 19 studies met our inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of a CEA-based panel were 0.45 (95% confidence interval [CI], 0.41-0.50), 0.89 (95% CI, 0.86-0.91), 5.39 (95% CI, 3.16-9.18), and 0.55 (95% CI, 0.41-0.72), respectively. The area under the curve (AUC, 0.90) and Q-value (0.84) of the CEA-based panel indicated a significantly higher diagnostic accuracy compared with CEA or CA19-9 alone. Moreover, there was also a significant association between high levels of CEA and worse overall survival (HR, 1.43; 95% CI, 1.31-1.56).
Our meta-analysis indicated that elevated serum CEA level, as a vital supplementary to CA19-9, can play an important role in the clinical diagnosis of pancreatic cancer patients and predict poor prognosis.
癌胚抗原（CEA）是应用最广泛的肿瘤标志物之一，30%-60%的胰腺癌患者其水平会升高。尽管糖类抗原19-9（CA19-9）是胰腺癌最重要的血清生物标志物，但CEA的诊断和预后价值正逐渐得到认可。
检索MEDLINE、EMBASE和科学引文索引数据库中截至2017年1月发表的相关文献。使用Meta-Disc软件汇总诊断准确性变量。使用Stata软件计算并分析预后数据的合并风险比（HR）。
19项研究中共有3650名参与者符合我们的纳入标准。基于CEA的检测组合的合并灵敏度、特异度、阳性似然比和阴性似然比分别为0.45（95%置信区间[CI]，0.41-0.50）、0.89（95%CI，0.86-0.91）、5.39（95%CI，3.16-9.18）和0.55（95%CI，0.41-0.72）。基于CEA的检测组合的曲线下面积（AUC，0.90）和Q值（0.84）表明，与单独使用CEA或CA19-9相比，其诊断准确性显著更高。此外，CEA高水平与较差的总生存期之间也存在显著关联（HR，1.43；95%CI，1.31-1.56）。
我们的荟萃分析表明，血清CEA水平升高作为CA19-9的重要补充，在胰腺癌患者的临床诊断中可发挥重要作用，并可预测不良预后。
