Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
Department of Oncology, University of Oxford, UK.
Cancer Epidemiol. 2019 Apr;59:15-21. doi: 10.1016/j.canep.2019.01.001. Epub 2019 Jan 15.
In this diagnostic test accuracy systematic review we summarise the evidence on the diagnostic accuracy of blood α-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH) in surveillance for testicular cancer recurrence in adults. We searched four electronic databases for studies that reported the diagnostic accuracy of HCG, AFP, and/or LDH in sufficient detail for sensitivity and specificity to be calculated by extracting a 2 × 2 table comparing biomarker positivity with testicular cancer recurrence. Screening, data extraction and QUADAS-2 quality assessment were completed by two independent reviewers. From 2406 studies, nine met our inclusion criteria. Eight reported data at the per-patient level. Sample sizes were small (range 5 to 449 patients) and clinical heterogeneity precluded meta-analysis. In most studies the specificity for recurrence with AFP and HCG was high (90-100%) but sensitivity was often relatively low, suggesting that many recurrences would not be detected by tumour markers alone. The diagnostic performance of LDH appears poorer. Studies were methodologically weak, with probable selection, incorporation and partial verification bias, and many studies were excluded for not reporting on recurrence-free patients. Limitations including small sample sizes, high heterogeneity, and inconsistent and incomplete reporting mean these results must be interpreted with caution. Despite inclusion of biomarkers in international surveillance guidance, there remains a lack of high quality evidence about their accuracy, optimal thresholds, and the most effective surveillance strategy in relation to contemporary investigative modalities. Higher quality research using data from modern-day follow-up cohorts is necessary to identify opportunities to reduce unnecessary testing.
在本次诊断测试准确性系统评价中，我们总结了有关血液甲胎蛋白（AFP）、人绒毛膜促性腺激素（HCG）和乳酸脱氢酶（LDH）在成人睾丸癌复发监测中的诊断准确性的证据。我们在四个电子数据库中搜索了足够详细地报告了 HCG、AFP 和/或 LDH 的诊断准确性的研究报告，以便通过提取比较生物标志物阳性与睾丸癌复发的 2×2 表格来计算敏感性和特异性。筛查、数据提取和 QUADAS-2 质量评估由两名独立的评审员完成。从 2406 项研究中，有 9 项符合我们的纳入标准。其中 8 项报告了按患者个体水平的数据。样本量较小（范围为 5 至 449 名患者），且临床异质性排除了荟萃分析。在大多数研究中，AFP 和 HCG 对复发的特异性很高（90-100%），但敏感性往往相对较低，这表明仅通过肿瘤标志物可能无法检测到许多复发。LDH 的诊断性能似乎较差。研究方法学较弱，存在可能的选择、纳入和部分验证偏倚，并且由于未报告无复发生存患者，许多研究被排除在外。局限性包括样本量小、高度异质性、不一致和不完整的报告，这意味着必须谨慎解释这些结果。尽管生物标志物已被纳入国际监测指南，但它们的准确性、最佳阈值以及与当代调查方式相关的最有效监测策略仍缺乏高质量证据。需要使用来自现代随访队列的数据进行更高质量的研究，以确定减少不必要检测的机会。
