尿液衍生外泌体诊断膀胱癌的准确性：系统评价和荟萃分析。
The diagnostic accuracy of urine-derived exosomes for bladder cancer: a systematic review and meta-analysis.
机构信息
Department of Clinical Laboratory, the Second Affiliated Hospital of Kunming Medical University, Kunming , Yunnan, 650000, China.
Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming , Yunnan, 650000, China.
出版信息
World J Surg Oncol. 2024 Oct 29;22(1):285. doi: 10.1186/s12957-024-03569-1.
INTRODUCTION
Urine-derived exosomes could potentially be biomarkers for bladder cancer (BC) diagnosis. This study aimed to systematically evaluate the diagnostic worth of urine-derived exosomes in BC patients through a meta-analysis of diverse studies.
METHODS
A systematic search was carried out in PubMed, Web of Science, Embase, Cochrane, and CNKI databases to obtain the literature concerning the diagnosis of BC via urine-derived exosomes. A literature retrieval strategy was devised to pick articles and extract needed data from the literature. QUADS-2 was used to evaluate the quality of the included literatures, and the aggregated diagnostic effect was assessed by calculating the area under the aggregated SROC curve. All statistical analyses and plots were conducted with STATA 14.0 and RevMan5.3.
RESULTS
A total of 678 articles were retrieved by means of the search strategy of the online database. Through screening, 21 articles were obtained, involving 3348 participants and 77 studies. The meta-analysis of the results indicated that urinary exosomes had a combined sensitivity of 0.75, a specificity of 0.77, and a combined AUC of 0.83 for the diagnosis of BC, suggesting that urine-derived exosomes have a relatively satisfactory diagnostic effect in the detection of BC. Among the subgroups classified by biomarker, long non-coding RNAs (lncRNAs) had the highest comprehensive sensitivity (SEN = 0.78), and miRNAs had the highest comprehensive specificity (SPN = 0.81). In other subgroup analyses, the biomarker panel for multiple exosomes combined diagnosis demonstrated the best diagnostic efficacy, with a combined the area under the curve ( AUC) of 0.87.
CONCLUSIONS
As a novel biomarker, urine-derived exosomes have significant diagnostic prospects in the diagnosis of BC. Nevertheless, their application in clinical settings still demands a considerable number of clinical trials to confirm their clinical feasibility and practicability.
简介
尿液来源的外泌体有可能成为膀胱癌（BC）诊断的生物标志物。本研究旨在通过对不同研究的荟萃分析，系统评估尿液来源的外泌体在 BC 患者中的诊断价值。
方法
系统检索 PubMed、Web of Science、Embase、Cochrane 和中国知网（CNKI）数据库，获取有关通过尿液来源的外泌体诊断 BC 的文献。设计文献检索策略以筛选文章并从文献中提取所需数据。使用 QUADS-2 评估纳入文献的质量，并通过计算汇总 SROC 曲线下面积来评估汇总诊断效果。所有统计分析和绘图均使用 STATA 14.0 和 RevMan5.3 进行。
结果
通过在线数据库的搜索策略共检索到 678 篇文章。经过筛选，获得了 21 篇文章，涉及 3348 名参与者和 77 项研究。结果的荟萃分析表明，尿外泌体对 BC 的诊断具有综合敏感性为 0.75、特异性为 0.77 和综合 AUC 为 0.83，提示尿液来源的外泌体在 BC 的检测中具有相对满意的诊断效果。在按生物标志物分类的亚组中，长链非编码 RNA（lncRNA）具有最高的综合敏感性（SEN=0.78），而 miRNA 具有最高的综合特异性（SPN=0.81）。在其他亚组分析中，多个外泌体联合诊断的生物标志物组合表现出最佳的诊断效果，曲线下面积（AUC）为 0.87。
结论
作为一种新型生物标志物，尿液来源的外泌体在 BC 的诊断中具有重要的应用前景。然而，其在临床应用中仍需要大量的临床试验来证实其临床可行性和实用性。
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