Lubis Masrul, Darmadi Darmadi, Samuel Surja Sem, Pakpahan Cennikon
Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Department of Parasitology, School of Medicine and Health Sciences, Universitas Katolik Indonesia Atma Jaya, Medan, Indonesia.
Caspian J Intern Med. 2024 Aug 30;15(4):559-569. doi: 10.22088/cjim.15.4.559. eCollection 2024 Fall.
Hepatocellular carcinoma (HCC) posed significant health problems and deaths. There are various challenges in the management of HCC, including the late detection or diagnosis. The ongoing diagnostic method in HCC also hinders the detection on the early stages of the disease, thus biomarkers need to be explored further for HCC detection. Serum alpha fetoprotein (AFP) and Midkine (MDK) are two proteins which might be the biomarker of choice in the detection of HCC. This meta-analysis aims to analyze the accuracy of Midkine and AFP in the detection of HCC.
The systematic review and meta-analysis was conducted by adhering to the Preferred Reporting System for Systematic Review and Meta-Analysis (PRISMA) guidelines. We conduct literature screening and selection followed by quality assessment from various databases such as PubMed, MEDLINE, SpringerLink, ProQuest, EBSCOhost, Cochrane, and EMBASE. The included studies were then extracted and analyzed cumulatively using MedCalc and MetaDTA with forest plot and ROC curve as outcome.
12 studies were included in this study. The AFP biomarker yields sensitivity value of 62.5% (97.5% CI 0.442 - 0.778) and specificity value of 95% (97.5% CI 0.842 - 0.986), while the Midkine biomarker denotes sensitivity value of 91.6% (97.5% CI 0.83 - 0.961) and specificity value of 82.2% (97.5% CI 0.83 - 0.96).
Both AFP and MDK are proven to be a good diagnostic tool or biomarker in the detection of HCC. The use of both in combination should provide high quality diagnostic marker for HCC suspected patients. Further studies on this should be conducted.
肝细胞癌（HCC）引发了严重的健康问题和死亡。HCC的管理存在各种挑战，包括检测或诊断延迟。目前的HCC诊断方法也阻碍了疾病早期阶段的检测，因此需要进一步探索用于HCC检测的生物标志物。血清甲胎蛋白（AFP）和中期因子（MDK）是两种可能成为HCC检测首选生物标志物的蛋白质。本荟萃分析旨在分析MDK和AFP在HCC检测中的准确性。
按照系统评价和荟萃分析的首选报告系统（PRISMA）指南进行系统评价和荟萃分析。我们进行文献筛选和选择，随后从PubMed、MEDLINE、SpringerLink、ProQuest、EBSCOhost、Cochrane和EMBASE等各种数据库进行质量评估。然后使用MedCalc和MetaDTA对纳入的研究进行累积提取和分析，以森林图和ROC曲线作为结果。
本研究纳入了12项研究。AFP生物标志物的敏感性值为62.5%（97.5%CI 0.442 - 0.778），特异性值为95%（97.5%CI 0.842 - 0.986），而MDK生物标志物的敏感性值为91.6%（97.5%CI 0.83 - 0.961），特异性值为82.2%（97.5%CI 0.83 - 0.96）。
AFP和MDK均被证明是检测HCC的良好诊断工具或生物标志物。两者联合使用应为疑似HCC患者提供高质量的诊断标志物。对此应开展进一步研究。
