维生素 K 缺乏或拮抗剂 II 诱导蛋白与甲胎蛋白在肝细胞癌诊断中的比较：系统评价与荟萃分析。

Protein induced by vitamin K absence or antagonist-II versus alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: A systematic review with meta-analysis.

机构信息

Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai 200438, China.

Medical Scientific Affairs, Abbott Diagnostics, Shanghai 200003, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2018 Dec;17(6):487-495. doi: 10.1016/j.hbpd.2018.09.009. Epub 2018 Sep 15.

DOI:10.1016/j.hbpd.2018.09.009

PMID:30257796

Abstract

BACKGROUND

As a promising biomarker of hepatocellular carcinoma (HCC), protein induced by vitamin K absence or antagonist-II (PIVKA-II) has been studied extensively. However, its diagnostic capability varies across HCC studies. This study aimed to compare the performance of PIVKA-II with alpha-fetoprotein (AFP) in the diagnosis of HCC.

DATA SOURCES

A systematic literature search was conducted to identify the studies from MEDLINE, Embase and Cochrane Library Databases, which were published up to December 20, 2017 to compare the diagnostic capability of PIVKA-II and AFP for HCC. The data were pooled using random effects model. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curve (ROC) was employed to evaluate the diagnostic accuracy of each marker.

RESULTS

Thirty-one studies were included. The pooled sensitivity (95% CI) of PIVKA-II and AFP was 0.66 (0.65-0.68) and 0.66 (0.65-0.67), respectively in diagnosis of HCC; and the corresponding pooled specificity (95% CI) was 0.89 (0.88-0.90) and 0.84 (0.83-0.85), respectively. The area under the ROC curve (AUC) of PIVKA-II and AFP was 0.856 (0.817-0.895) and 0.770 (0.728-0.811), respectively. Subgroup analysis showed that PIVKA-II was superior to AFP in terms of the AUC for both small HCC (< 3 cm) [0.863 (0.825-0.901) vs 0.717 (0.658-0.776)] and large HCC (≥ 3 cm) [0.854 (0.811-0.897) vs 0.729 (0.682-0.776)]; for American [0.926 (0.897-0.955) vs 0.698 (0.594-0.662)], European [0.772 (0.743-0.801) vs 0.628 (0.594-0.662)], Asian [0.838 (0.812-0.864) vs 0.785 (0.764-0.806)] and African [0.812 (0.794-0.840) vs 0.721 (0.675-0.767)] HCC patients; and for HBV-related [0.909 (0.866-0.951) vs 0.714 (0.673-0.755)] and mixed-etiology [0.847 (0.821-0.873) vs 0.794 (0.772-0.816)] HCC.

CONCLUSION

This meta-analysis indicates that PIVKA-II is better than AFP in terms of the accuracy for diagnosing HCC, regardless of tumor size, patient ethnic group, or HCC etiology.

摘要

背景

蛋白诱导的维生素 K 缺乏或拮抗剂-II（PIVKA-II）作为肝细胞癌（HCC）的一种有前途的生物标志物，已被广泛研究。然而，其在不同 HCC 研究中的诊断能力存在差异。本研究旨在比较 PIVKA-II 与甲胎蛋白（AFP）在 HCC 诊断中的性能。

资料来源

系统检索 MEDLINE、Embase 和 Cochrane 图书馆数据库，检索截至 2017 年 12 月 20 日的文献，以比较 PIVKA-II 和 AFP 对 HCC 的诊断能力。使用随机效应模型对数据进行汇总。计算合并敏感性和特异性。采用综合受试者工作特征曲线（ROC）评估每个标志物的诊断准确性。

结果

共纳入 31 项研究。PIVKA-II 和 AFP 诊断 HCC 的合并敏感性（95%CI）分别为 0.66（0.65-0.68）和 0.66（0.65-0.67）；相应的合并特异性（95%CI）分别为 0.89（0.88-0.90）和 0.84（0.83-0.85）。PIVKA-II 和 AFP 的 ROC 曲线下面积（AUC）分别为 0.856（0.817-0.895）和 0.770（0.728-0.811）。亚组分析显示，对于小 HCC（<3cm）[0.863（0.825-0.901）比 0.717（0.658-0.776）]和大 HCC（≥3cm）[0.854（0.811-0.897）比 0.729（0.682-0.776）]，PIVKA-II 优于 AFP；对于美国[0.926（0.897-0.955）比 0.698（0.594-0.662）]、欧洲[0.772（0.743-0.801）比 0.628（0.594-0.662）]、亚洲[0.838（0.812-0.864）比 0.785（0.764-0.806）]和非洲[0.812（0.794-0.840）比 0.721（0.675-0.767）]的 HCC 患者，PIVKA-II 优于 AFP；对于 HBV 相关[0.909（0.866-0.951）比 0.714（0.673-0.755）]和混合病因[0.847（0.821-0.873）比 0.794（0.772-0.816）]的 HCC，PIVKA-II 优于 AFP。