Pang Caishuang, Ma Huiwen, Qin Jiangyue, Wang Sixiong, Wan Chun, Yang Ting, Shen Yongchun, Wang Donglin
Chongqing University Cancer Hospital& Chongqing Cancer Institute & Chongqing Cancer Hospital and Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing.
Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China.
Medicine (Baltimore). 2019 May;98(18):e15450. doi: 10.1097/MD.0000000000015450.
Pleural effusion (PE) has been reported useful in many studies for testing epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) with variable results. This systematic review and meta-analysis was performed to elucidate whether PE could be used as a surrogate for tumor tissue to detect EGFR mutations.
We extracted 2 × 2 diagnostic table from each included study and calculated data on specificity, sensitivity, negative likelihood ratio (NLR), positive likelihood ratio (PLR) ,and diagnostic odds ratio (DOR). We used the area under curve (AUC) and summary receiver operating characteristic curve (SROC) to summarize the overall diagnostic performance and assessed publication bias by Deeks' funnel plot.
Our meta-analysis included 15 eligible publications. The following summary estimates for diagnostic parameters of the EGFR mutations detection in PE were made: sensitivity, 0.86 (95%CI 0.83-0.89); specificity, 0.93 (95%CI 0.91-0.95); PLR, 8.53 (95%CI 5,94-12.25); NLR, 0.18 (95%CI 0.13-0.25); DOR, 63.40 (95%CI 38.83-103.51); and AUC, 0.94. Funnel plot indicated publication bias insignificant.
The meta-analysis suggests that EGFR mutation detecting in PE, especially supernatants, is a promising surrogate for tumor tissue in EGFR mutations testing of patients with NSCLC.
在许多研究中，已报道胸腔积液（PE）对检测非小细胞肺癌（NSCLC）中的表皮生长因子受体（EGFR）突变有用，但结果各异。进行这项系统评价和荟萃分析以阐明PE是否可作为肿瘤组织的替代物来检测EGFR突变。
我们从每项纳入研究中提取2×2诊断表，并计算特异性、敏感性、阴性似然比（NLR）、阳性似然比（PLR）和诊断比值比（DOR）的数据。我们使用曲线下面积（AUC）和汇总受试者工作特征曲线（SROC）来总结总体诊断性能，并通过Deeks漏斗图评估发表偏倚。
我们的荟萃分析纳入了15篇符合条件的出版物。对PE中EGFR突变检测的诊断参数进行了以下汇总估计：敏感性为0.86（95%CI 0.83 - 0.89）；特异性为0.93（95%CI 0.91 - 0.95）；PLR为8.53（95%CI 5.94 - 12.25）；NLR为0.18（95%CI 0.13 - 0.25）；DOR为63.40（95%CI 38.83 - 103.51）；AUC为0.94。漏斗图表明发表偏倚不显著。
荟萃分析表明，在NSCLC患者的EGFR突变检测中，检测PE（尤其是上清液）中的EGFR突变是一种有前景的肿瘤组织替代方法。
