Feng Yiwei, Xia Wei, He Guangyao, Ke Rongdan, Liu Lei, Xie Mao, Tang Anzhou, Yi Xiang
Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
First Clinical Medical College, Guangxi Medical University, Nanning, China.
Front Oncol. 2020 Sep 18;10:1779. doi: 10.3389/fonc.2020.01779. eCollection 2020.
The aim of the present study was to collect published studies and compare the diagnostic accuracy of different markers for nasopharyngeal carcinoma (NPC). We systematically searched PubMed/MEDLINE, EMBASE, Cochrane Library, CNKI, and Wanfang for relevant studies until April 29, 2020. The revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the methodological quality of the studies. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) values of the diagnostic markers were combined by a bivariate mixed effect model to compare their diagnostic accuracy. We explored heterogeneity through meta-regression. In total, 244 records from 101 articles were included, with 49,432 total study subjects (13,109 cases and 36,323 controls). EA-IgG, Zta-IgG, and Epstein-Barr virus (EBV) DNA load in non-invasive nasopharyngeal brushings (EBV-DNA brushings) have both high sensitivity and specificity, EBNA1-IgG and VCA-IgG have only high sensitivity, and EBNA1-IgA, VCA-IgA, Rta-IgG, Zta-IgA, HSP70, and serum sialic acid (SA) have only high specificity. The bivariate mixed effect model of EA-IgA had a significant threshold effect. Meta-regression analysis showed that ethnicity affected EBNA1-IgA, EBNA1-IgG, VCA-IgA, and EBV DNA load in plasma, test methods affected EBNA1-IgG, publication year affected VCA-IgA, and sample size affected Rta-IgG. There was significant publication bias for VCA-IgA and Rta-IgG ( < 0.05). EA-IgG, Zta-IgG, and EBV-DNA brushings are good diagnostic markers for NPC. The diagnostic accuracy was influenced by publication year, sample size, test methods, and ethnicity.
本研究的目的是收集已发表的研究，并比较不同标志物对鼻咽癌（NPC）的诊断准确性。我们系统检索了PubMed/MEDLINE、EMBASE、Cochrane图书馆、中国知网和万方数据库，以获取截至2020年4月29日的相关研究。采用修订后的诊断准确性研究质量评估（QUADAS-2）工具来评估研究的方法学质量。通过双变量混合效应模型合并诊断标志物的敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）和曲线下面积（AUC）值，以比较它们的诊断准确性。我们通过Meta回归探索异质性。总共纳入了101篇文章中的244条记录，共有49432名研究对象（13109例病例和36323名对照）。EA-IgG、Zta-IgG和无创鼻咽刷检中的爱泼斯坦-巴尔病毒（EBV）DNA载量（EBV-DNA刷检）均具有高敏感性和特异性，EBNA1-IgG和VCA-IgG仅具有高敏感性，而EBNA1-IgA、VCA-IgA、Rta-IgG、Zta-IgA、HSP70和血清唾液酸（SA）仅具有高特异性。EA-IgA的双变量混合效应模型有显著的阈值效应。Meta回归分析表明，种族影响血浆中EBNA1-IgA、EBNA1-IgG、VCA-IgA和EBV DNA载量，检测方法影响EBNA1-IgG，发表年份影响VCA-IgA，样本量影响Rta-IgG。VCA-IgA和Rta-IgG存在显著的发表偏倚（<0.05）。EA-IgG、Zta-IgG和EBV-DNA刷检是NPC的良好诊断标志物。诊断准确性受发表年份、样本量、检测方法和种族的影响。
