Zhu Tingting, Peng Xiaolin, Cheng Ziwei, Xing Dongwei, Zhang Minguang
Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Ann Palliat Med. 2021 Apr;10(4):4025-4036. doi: 10.21037/apm-20-2013. Epub 2021 Mar 23.
Epithelial cell adhesion molecule (EpCAM) is one of the most commonly used markers of cancer stem cells (CSCs). However, the diagnostic and prognostic significance of EpCAM in lung cancer remains largely undetermined. In the present study, we systematically summarized and elucidated the correlation between EpCAM overexpression and lung cancer through a meta-analysis.
Six databases (PubMed, Web of Science, Cochrane Library, and Embase, CnKI and Wanfang Database) were systematically searched. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) criteria were adopted to assess the qualities of the included studies. Relevant data were extracted for meta-analysis using the Stata12.0 software. Unadjusted mixed odds ratios (ORs) or hazard ratios (HRs) with 95% confidence interval (95% CI) were estimated to evaluate the correlation between EpCAM overexpression and lung cancer. The sensitivity and specificity of the included studies were used to construct the summary receiver operator characteristic (SROC) curve and calculate the area under the SROC curve (AUC).
A total of 14 studies consisting of 2,658 lung cancer patients were included following the PICOS principle. We found that the EpCAM expression was significantly higher in lung cancer patients compared with normal controls, including patients with benign pulmonary diseases (OR =63.71, 95% CI, 14.59-278.21, P=0.003) and healthy individuals (OR =520.08, 95% CI, 16.38-16,510.80, P=0.002), and its overexpression was negatively associated with the TNM stage (III + IV) (OR =0.41, 95% CI, 0.21-0.82, P=0.073. The combined sensitivity and specificity of EpCAM overexpression in the diagnosis of lung cancer were 0.79 (95% CI, 0.59-0.90) and 0.98 (95% CI, 0.95-0.99), respectively, and the SROC-AUC was 0.98 (95% CI, 0.97-0.99). Multivariate analysis of 322 lung cancer patients showed that there was no significant correlation between the EpCAM overexpression and prognosis of lung cancer (HR =2.28, 95% CI, 0.80-6.51, P=0.002). Deeks' funnel plot analysis showed the existence of publication bias (P=0.000).
Our present findings suggested that EpCAM overexpression was not sensitive enough to predict the prognosis of lung cancer. Moreover, it was also a potential diagnostic indicator for lung cancer and correlated with TNM staging of lung cancer.
上皮细胞粘附分子（EpCAM）是癌症干细胞（CSCs）最常用的标志物之一。然而，EpCAM在肺癌中的诊断和预后意义仍 largely未确定。在本研究中，我们通过荟萃分析系统地总结并阐明了EpCAM过表达与肺癌之间的相关性。
系统检索了六个数据库（PubMed、Web of Science、Cochrane图书馆、Embase、中国知网和万方数据库）。采用诊断准确性研究质量评估-2（QUADAS-2）标准评估纳入研究的质量。使用Stata12.0软件提取相关数据进行荟萃分析。估计未调整的混合比值比（OR）或风险比（HR）及95%置信区间（95%CI），以评估EpCAM过表达与肺癌之间的相关性。纳入研究的敏感性和特异性用于构建汇总受试者工作特征（SROC）曲线并计算SROC曲线下面积（AUC）。
遵循PICOS原则共纳入了14项研究，包括2658例肺癌患者。我们发现，与正常对照相比，肺癌患者的EpCAM表达显著更高，正常对照包括良性肺部疾病患者（OR =63.71，95%CI，14.59 - 278.21，P =0.003）和健康个体（OR =520.08，95%CI，16.38 - 16510.80，P =0.002），且其过表达与TNM分期（III + IV期）呈负相关（OR =0.41，95%CI，0.21 - 0.82，P =0.073）。EpCAM过表达在肺癌诊断中的联合敏感性和特异性分别为0.79（95%CI，0.59 - 0.90）和0.98（95%CI，0.95 - 0.99），SROC-AUC为0.98（95%CI，0.97 - 0.99）。对322例肺癌患者的多变量分析表明，EpCAM过表达与肺癌预后之间无显著相关性（HR =2.28，95%CI，0.80 - 6.51，P =0.002）。Deeks漏斗图分析显示存在发表偏倚（P =0.000）。
我们目前的研究结果表明，EpCAM过表达对预测肺癌预后的敏感性不足。此外，它也是肺癌的潜在诊断指标，且与肺癌的TNM分期相关。
