Department of Epidemiology and Biostatistics, School of Health, Birjand University of Medical Sciences, Birjand, Iran.
Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
Expert Rev Mol Diagn. 2023 Jul-Dec;23(11):971-983. doi: 10.1080/14737159.2023.2260306. Epub 2023 Sep 15.
Early and non-invasive detection of hepatocellular carcinoma (HCC), which is usually asymptomatic, can improve overall survival outcomes. The objective of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of serum-derived exosomes for diagnosing HCC.
PubMed, Web of Science, and Scopus databases were searched for relevant studies up to April 2023. The quality of included studies was assessed using the QUADAS-2 checklist, and data were extracted. Statistical analysis was performed on 18 studies from 3,993 records, and a diagnostic meta-analysis was conducted. Biomarkers were categorized into four groups based on their type (exosomal miRNAs, exosomal RNAs, alpha-fetoprotein (AFP), and exosomal RNAs+AFP panel), and a meta-analysis was conducted for each category separately.
The highest pooled sensitivity was 0.86 for exosomal miRNAs, and exosomal RNAs+AFP had the highest pooled specificity; (0.89). Furthermore, exosomal RNAs+AFP had the highest pooled positive likelihood ratio; (7.55), the highest pooled diagnostic odds ratio (35.96) and the highest pooled area under the curve (0.93). Exosomal miRNAs had the lowest pooled negative likelihood ratio; (0.17).
The diagnostic accuracy of exosomal biomarkers is superior to that of AFP, and combining the two in a panel yields the better results.
早期和非侵入性检测通常无症状的肝细胞癌 (HCC) 可以改善整体生存结果。本系统评价和荟萃分析的目的是评估血清来源的外泌体诊断 HCC 的诊断准确性。
截至 2023 年 4 月，我们在 PubMed、Web of Science 和 Scopus 数据库中搜索了相关研究。使用 QUADAS-2 清单评估纳入研究的质量，并提取数据。对来自 3993 条记录的 18 项研究进行统计分析，并进行诊断荟萃分析。根据标志物的类型（外泌体 miRNAs、外泌体 RNA、甲胎蛋白 (AFP) 和外泌体 RNA+AFP 组合）将其分为四组，并分别对每组进行荟萃分析。
外泌体 miRNAs 的最高合并敏感度为 0.86，外泌体 RNA+AFP 的最高合并特异度为 0.89。此外，外泌体 RNA+AFP 具有最高的合并阳性似然比 (7.55)、最高的合并诊断比值比 (35.96) 和最高的合并曲线下面积 (0.93)。外泌体 miRNAs 具有最低的合并阴性似然比 (0.17)。
外泌体标志物的诊断准确性优于 AFP，联合使用两种标志物可获得更好的结果。
