年龄会影响恶性胸腔积液中癌比率的诊断准确性。
Age affects the diagnostic accuracy of the cancer ratio for malignant pleural effusion.
机构信息
Department of Pulmonary and Critical Care Medicine, the Affiliated Changshu Hospital of Nantong University, 215500, Changshu, China.
Department of Key Laboratory, the Affiliated Changshu Hospital of Nantong University, 215500, Changshu, China.
出版信息
BMC Pulm Med. 2023 Jun 7;23(1):198. doi: 10.1186/s12890-023-02475-8.
BACKGROUND AND OBJECTIVE
Cancer ratio (CR), which is defined as serum lactate dehydrogenase (LDH) to pleural fluid adenosine deaminase (ADA) ratio, has been reported to be a useful diagnostic marker for malignant pleural effusion (MPE). Whether its diagnostic accuracy is affected by age remains unknown. This study aimed to investigate the effects of age on the diagnostic accuracy of CR.
METHODS
The participants in this study were from a prospective cohort (SIMPLE cohort, n = 199) and a retrospective cohort (BUFF cohort, n = 158). All participants were patients with undiagnosed pleural effusion (PE). We used receiver operating characteristic (ROC) curves to evaluate the diagnostic accuracy of CR. The effect of age on the diagnostic accuracy of CR was investigated by adjusting the upper limit of age for participant enrolment.
RESULTS
Eighty-eight MPE patients were verified in the SIMPLE cohort, and thirty-five MPE patients were verified in the BUFF cohort. The AUCs of CR in the SIMPLE and BUFF cohorts were 0.60 (95% CI: 0.52-0.68) and 0.63 (95% CI: 0.54-0.71), respectively. In both cohorts, the AUCs of CR decreased with the advancement of age.
CONCLUSION
Age can affect the diagnostic accuracy of CR for MPE. CR has limited diagnostic value in older patients.
KEY MESSAGE
Cancer ratio is a promising diagnostic marker for malignant pleural effusion. This study revealed that its diagnostic accuracy decreased in older patients. Its diagnostic accuracy is overestimated by previous studies using tuberculosis and pneumonia patients as controls.
背景与目的
癌症比（CR）定义为血清乳酸脱氢酶（LDH）与胸腔液腺苷脱氨酶（ADA）的比值，已被报道为恶性胸腔积液（MPE）的一种有用的诊断标志物。其诊断准确性是否受年龄影响尚不清楚。本研究旨在探讨年龄对 CR 诊断准确性的影响。
方法
本研究的参与者来自一个前瞻性队列（SIMPLE 队列，n=199）和一个回顾性队列（BUFF 队列，n=158）。所有参与者均为诊断不明的胸腔积液（PE）患者。我们使用受试者工作特征（ROC）曲线评估 CR 的诊断准确性。通过调整参与者入组的年龄上限，研究年龄对 CR 诊断准确性的影响。
结果
在 SIMPLE 队列中，有 88 例 MPE 患者得到验证，在 BUFF 队列中有 35 例 MPE 患者得到验证。CR 在 SIMPLE 和 BUFF 队列中的 AUC 分别为 0.60（95%CI：0.52-0.68）和 0.63（95%CI：0.54-0.71）。在两个队列中，CR 的 AUC 均随年龄的增长而降低。
结论
年龄会影响 CR 对 MPE 的诊断准确性。CR 对老年患者的诊断价值有限。
关键信息
癌症比是一种有前途的恶性胸腔积液诊断标志物。本研究表明，其在老年患者中的诊断准确性降低。以前使用结核和肺炎患者作为对照的研究高估了其诊断准确性。
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