Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands.
Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands.
J Pediatr Surg. 2020 Sep;55(9):1732-1739. doi: 10.1016/j.jpedsurg.2020.03.014. Epub 2020 Apr 1.
The incidence of children developing recurrent sacrococcygeal teratoma (SCT) is 2-35%. Serum alpha-fetoprotein (AFP) is often used as a tumor marker for (malignant) recurrences of SCT and could potentially be used during routine follow-up after SCT resection. However, the diagnostic accuracy of serum AFP levels during follow-up has not been well established. Therefore, we aimed to systematically review the diagnostic accuracy of serum AFP levels in recurrent SCT.
We queried Search Premier, COCHRANE Library, EMCARE, EMBASE, PubMed, ScienceDirect and Web of Science databases to identify studies regarding patients with SCT with follow-up using serum AFP levels postoperative. We estimated sensitivity and specificity of serum AFP levels.
Fifteen studies (613 patients, 121 recurrences) were included and these mainly described serum AFP levels in patients with recurrent SCT (n = 111); 83 (75%) patients with recurrent SCT had elevated serum AFP levels. A subgroup analysis of articles that measured serum AFP levels in all patients (n = 6, 136 patients, 14 recurrences) showed a sensitivity and specificity of 79% and 95%, respectively. The sensitivity of AFP levels to detect malignant recurrence was 96%.
Diagnostic accuracy of serum AFP levels to detect recurrent SCT seems promising, though sensitivity could be overestimated since serum AFP levels are mainly described in patients with elevated AFP levels or at recurrent SCT. Furthermore, serum AFP levels could be helpful to detect malignant recurrences.
Systematic review of level 2-4 studies.
Level 2-4 (mostly level 2).
儿童复发性尾骨畸胎瘤（SCT）的发病率为 2-35%。血清甲胎蛋白（AFP）常用于 SCT （恶性）复发的肿瘤标志物，并且可能在 SCT 切除后常规随访期间使用。然而，血清 AFP 水平在随访期间的诊断准确性尚未得到很好的确定。因此，我们旨在系统地回顾血清 AFP 水平在复发性 SCT 中的诊断准确性。
我们在 Search Premier、COCHRANE 图书馆、EMCARE、EMBASE、PubMed、ScienceDirect 和 Web of Science 数据库中查询了使用术后血清 AFP 水平对 SCT 患者进行随访的研究。我们估计了血清 AFP 水平的敏感性和特异性。
共纳入 15 项研究（613 例患者，121 例复发），主要描述了复发性 SCT 患者的血清 AFP 水平（n=111）；83（75%）例复发性 SCT 患者的血清 AFP 水平升高。对测量所有患者血清 AFP 水平的文章进行亚组分析（n=6，136 例患者，14 例复发），显示敏感性和特异性分别为 79%和 95%。AFP 水平检测恶性复发的敏感性为 96%。
血清 AFP 水平检测复发性 SCT 的诊断准确性似乎很有希望，尽管敏感性可能被高估，因为血清 AFP 水平主要描述了 AFP 水平升高或复发性 SCT 的患者。此外，血清 AFP 水平可能有助于检测恶性复发。
2-4 级研究的系统评价。
2-4 级（大多为 2 级）。
