Xi'an Jiaotong University Health Science Center, Xi'an, China.
The First School of Clinical Medicine, Xi'an, China.
Eur J Gastroenterol Hepatol. 2022 Sep 1;34(9):891-904. doi: 10.1097/MEG.0000000000002415. Epub 2022 Jul 27.
Carbohydrate antigen 19-9 (CA19-9) is the most widely used serum biomarker for detecting pancreatic cancer (PC). Since early diagnosis is important for improving PC prognosis, a comprehensive understanding of the diagnostic performance of CA19-9 is critical. This study focused on comprehensive evaluation of the efficacy of CA19-9 in PC diagnosis. Literature research was based on the seven databases. Studies released from January 2002 to January 2022 focused on the efficacy of CA19-9 in the detection of PC were included. Summarized sensitivity, specificity, and sROC/accuracy of discrimination (AUC) were estimated. Potential publication bias was measured with Funnel plot and Egger's test. Meta-regression was performed to detect possible causes of heterogeneity. Subgroup analysis was used to assess the diagnostic efficacy of CA19-9 under different conditions. The study is registered on PROSPERO (CRD42021253861). Seventy-nine studies containing 20 991 participants who met the criteria were included. The pooled sensitivity, specificity, and AUC of CA19-9 in diagnose PC were 72% (95% CI, 71-73%), 86% (95% CI, 85-86%), and 0.8474 (95% CI, 0.8272-0.8676). Subgroup analysis suggested that the diagnostic efficiency of CA19-9 in studies with healthy controls was the highest, followed by intraductal papillary mucinous neoplasm, in pancreatitis and diabetes were consistent with the overall result. Our analysis showed that serum CA19-9 had high and stable diagnostic efficacy for PC (not affected by diabetes). Subgroup analysis showed that serum CA19-9 yielded highest effectiveness in the diagnosis of pancreatic precancerous lesions, which indicated an irreplaceable clinical value in the early detection and warning value for PC.
糖类抗原 19-9（CA19-9）是最常用于检测胰腺癌（PC）的血清生物标志物。由于早期诊断对改善 PC 预后很重要，因此全面了解 CA19-9 的诊断性能至关重要。本研究重点评估 CA19-9 在 PC 诊断中的疗效。文献研究基于 7 个数据库。纳入 2002 年 1 月至 2022 年 1 月发布的、关注 CA19-9 检测 PC 功效的研究。估计汇总的敏感性、特异性和区分度的 sROC/准确性（AUC）。采用漏斗图和 Egger 检验测量潜在的发表偏倚。进行 Meta 回归以检测异质性的可能原因。使用亚组分析评估 CA19-9 在不同条件下的诊断效果。该研究已在 PROSPERO（CRD42021253861）上注册。纳入了 79 项研究，共包含 20991 名符合标准的参与者。CA19-9 诊断 PC 的汇总敏感性、特异性和 AUC 分别为 72%（95%CI，71-73%）、86%（95%CI，85-86%）和 0.8474（95%CI，0.8272-0.8676）。亚组分析表明，CA19-9 在以健康对照为研究对象的研究中诊断效率最高，其次是胰胆管内乳头状黏液性肿瘤，在胰腺炎和糖尿病中与总体结果一致。我们的分析表明，血清 CA19-9 对 PC 具有较高且稳定的诊断功效（不受糖尿病影响）。亚组分析表明，血清 CA19-9 在诊断胰腺癌前病变时效果最佳，这表明其在 PC 的早期检测和预警方面具有不可替代的临床价值。
