尿纤维连接蛋白作为膀胱癌患者非侵入性诊断生物标志物的有效性：系统评价和荟萃分析。
Effectiveness of urine fibronectin as a non-invasive diagnostic biomarker in bladder cancer patients: a systematic review and meta-analysis.
机构信息
Department of Urology, Huashan Hospital, Fudan University, No.12, Middle Urumqi Road, Shanghai, 200040, China.
Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China.
出版信息
World J Surg Oncol. 2018 Mar 21;16(1):61. doi: 10.1186/s12957-018-1358-x.
BACKGROUND
Previous researches pointed out that the measurement of urine fibronectin (Fn) could be a potential diagnostic test for bladder cancer (BCa). We conducted this meta-analysis to fully assess the diagnostic value of urine Fn for BCa detection.
METHODS
A systematic literature search in PubMed, ISI Web of Science, EMBASE, Cochrane library, and CBM was carried out to identify eligible studies evaluating the urine Fn in diagnosing BCa. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with their 95% confidence intervals (CIs) were calculated, and summary receiver operating characteristic (SROC) curves were established. We applied the STATA 13.0, Meta-Disc 1.4, and RevMan 5.3 software to the meta-analysis.
RESULTS
Eight separate studies with 744 bladder cancer patients were enrolled in this meta-analysis. The pooled sensitivity, specificity, and DOR were 0.80 (95%CI = 0.77-0.83), 0.79 (95%CI = 0.73-0.84), and 15.18 (95%CI = 10.07-22.87), respectively, and the area under the curve (AUC) of SROC was 0.83 (95%CI = 0.79-0.86). The diagnostic power of a combined method (urine Fn combined with urine cytology) was also evaluated, and its sensitivity and AUC were significantly higher (0.86 (95%CI = 0.82-0.90) and 0.89 (95%CI = 0.86-0.92), respectively). Meta-regression along with subgroup analysis based on various covariates revealed the potential sources of the heterogeneity and the detailed diagnostic value of each subgroup. Sensitivity analysis supported that the result was robust. No threshold effect and publication bias were found in this meta-analysis.
CONCLUSIONS
Urine Fn may become a promising non-invasive biomarker for bladder cancer with a relatively satisfactory diagnostic power. And the combination of urine Fn with cytology could be an alternative option for detecting BCa in clinical practice. The potential value of urine Fn still needs to be validated in large, multi-center, and prospective studies.
背景
先前的研究指出，尿液纤维连接蛋白（Fn）的测量可能是膀胱癌（BCa）的潜在诊断测试。我们进行了这项荟萃分析，以充分评估尿液 Fn 检测膀胱癌的诊断价值。
方法
在 PubMed、ISI Web of Science、EMBASE、Cochrane 图书馆和 CBM 中进行系统的文献检索，以确定评估尿液 Fn 诊断 BCa 的合格研究。计算合并敏感性、特异性和诊断比值比（DOR）及其 95%置信区间（CI），并建立汇总受试者工作特征（SROC）曲线。我们使用 STATA 13.0、Meta-Disc 1.4 和 RevMan 5.3 软件进行荟萃分析。
结果
这项荟萃分析共纳入了 8 项独立研究的 744 例膀胱癌患者。合并敏感性、特异性和 DOR 分别为 0.80（95%CI=0.77-0.83）、0.79（95%CI=0.73-0.84）和 15.18（95%CI=10.07-22.87），SROC 的曲线下面积（AUC）为 0.83（95%CI=0.79-0.86）。还评估了联合方法（尿液 Fn 联合尿液细胞学）的诊断效能，其敏感性和 AUC 明显更高（0.86（95%CI=0.82-0.90）和 0.89（95%CI=0.86-0.92））。基于各种协变量的荟萃回归和亚组分析揭示了异质性的潜在来源和每个亚组的详细诊断价值。敏感性分析支持结果稳健。这项荟萃分析未发现阈值效应和发表偏倚。
结论
尿液 Fn 可能成为一种有前途的非侵入性膀胱癌生物标志物，具有相对满意的诊断效能。尿液 Fn 联合细胞学检查可能是临床检测 BCa 的另一种选择。尿液 Fn 的潜在价值仍需要在大型、多中心和前瞻性研究中验证。
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