Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China.
Ann Med. 2021 Dec;53(1):558-566. doi: 10.1080/07853890.2021.1906943.
This study aimed to assess the diagnostic accuracy of serum LDH to pleural ADA ratio (cancer ratio, CR)for malignant pleural effusion (MPE) through an original study and meta-analysis.
We retrospectively collected data from 145 patients with MPE and 117 cases of benign pleural effusions (BPE). The diagnostic performance of CR and a typical biomarker of MPE, carcinoembryonic antigen (CEA), were analysed using the receiver operating characteristic (ROC) curves and the area under the curve (AUC) as a measure of accuracy. The overall diagnostic accuracy of CR was summarised by a standard diagnostic meta-analysis.
Significantly higher CR and pleural CEA values were observed in the MPE patients than in the BPE patients. At a cut-off value of 14.97, CR showed high sensitivity (0.91), low specificity (0.67), and high AUC (0.85). The combination of CEA and CR increased the AUC to 0.98. The meta-analysis included seven studies involving 2,078 patients. The pooled values for sensitivity, specificity, positive/negative likelihood ratio, and diagnostic odds ratio of CR were 0.96, 0.88, 7.70, 0.05, and 169, respectively. The AUC of the summary ROC of CR was 0.98.
CR has a high diagnostic accuracy for predicting MPE, especially when used in combination with pleural CEA.
本研究旨在通过原始研究和荟萃分析评估血清 LDH 与胸腔 ADA 比值（癌症比值，CR）对恶性胸腔积液（MPE）的诊断准确性。
我们回顾性收集了 145 例 MPE 患者和 117 例良性胸腔积液（BPE）患者的数据。使用接收者操作特征（ROC）曲线和曲线下面积（AUC）作为准确性的衡量标准，分析 CR 和 MPE 的典型标志物癌胚抗原（CEA）的诊断性能。CR 的总体诊断准确性通过标准诊断荟萃分析进行总结。
MPE 患者的 CR 和胸腔 CEA 值明显高于 BPE 患者。在 14.97 的截断值下，CR 表现出高灵敏度（0.91）、低特异性（0.67）和高 AUC（0.85）。CEA 和 CR 的联合使用将 AUC 提高到 0.98。荟萃分析纳入了 7 项涉及 2078 例患者的研究。CR 的敏感性、特异性、阳性/阴性似然比和诊断比值比的汇总值分别为 0.96、0.88、7.70、0.05 和 169，AUC 为 0.98。
CR 对预测 MPE 具有较高的诊断准确性，特别是与胸腔 CEA 联合使用时。
