Ungureanu Bogdan Silviu, Gheonea Dan Ionut, Turcu-Stiolica Adina, Schenker Michael, Pirici Daniel, Vere Cristin-Constantin, Fierut Andrei, Saftoiu Adrian
Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Biostatistics Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Stem Cell Res Ther. 2025 Aug 27;16(1):463. doi: 10.1186/s13287-025-04601-1.
Recent evidence suggests that EpCAM and CD44 could serve as diagnosis or prognosis markers in pancreatic cancer (PC). In this meta-analysis, we evaluated their associations with clinicopathologic features. Specifically, we compared immunohistochemical-positive and -negative PC patients for T stage (T3-T4 vs. T1-T2), N stage (N1 vs. N0), M stage (M1 vs. M0), tumor grade (well/moderately vs. poorly differentiated), UICC Stage (III, IV vs. I, II), and overall survival (OS). The diagnostic meta-analysis was performed analysing the pooled sensitivity and specificity and evaluating overall accuracy to indicate the diagnostic efficacy of the markers. The protocol of this systematic review and meta-analysis was registered on the PROSPERO website under the registration number of CRD42024568390. A systematic search of PubMed, Scopus, and ISI Web of Science was conducted on January 30th, 2025. The statistical analysis was performed using the Review Manager 5.4 software and R language (R package Mada and Metafor). The quality of the studies included was assessed using the Newcastle-Ottawa scale and the QUADAS-2 tool. Data from relevant studies were independently screened and extracted using Rayyan, by at least two authors. A total of 19 studies were eligible (9 studies for EpCAM, 9 studies for CD44, and 2 studies for both EpCAM and CD44), comprising a total of 1370 patients. The diagnostic meta-analysis demonstrated moderate accuracy for EpCAM (AUC, 95% CI of 0.802, 0.69-0.96). A statistically significant association was found for CD44 expression and T-status (OR = 2.04, 95%CI = 1.18-3.51), or N-stage (OR = 2.68, 95%CI = 1.86-3.85), or TNM stage (OR = 3.79, 95%CI = 2.14-6.71). CD44v6 overexpression predicted worse OS (HR = 2.33, p < 0.00001), while EpCAM + CD44 + co-expression was prognostic (HR = 2.02, p = 0.02). Heterogeneity was not observed among the studies included, but further research is warranted to better understand the clinical implications of these markers' positivity in PC diagnosis and prognosis.
近期证据表明，上皮细胞黏附分子（EpCAM）和CD44可作为胰腺癌（PC）的诊断或预后标志物。在这项荟萃分析中，我们评估了它们与临床病理特征的关联。具体而言，我们比较了免疫组化阳性和阴性的PC患者在T分期（T3 - T4与T1 - T2）、N分期（N1与N0）、M分期（M1与M0）、肿瘤分级（高/中分化与低分化）、国际抗癌联盟（UICC）分期（III、IV期与I、II期）以及总生存期（OS）方面的差异。进行诊断性荟萃分析时，分析了合并敏感性和特异性，并评估总体准确性以表明标志物的诊断效能。本系统评价和荟萃分析的方案已在PROSPERO网站注册，注册号为CRD42024568390。2025年1月30日对PubMed、Scopus和ISI科学网进行了系统检索。使用Review Manager 5.4软件和R语言（R包Mada和Metafor）进行统计分析。使用纽卡斯尔 - 渥太华量表和QUADAS - 2工具评估纳入研究的质量。相关研究的数据由至少两名作者使用Rayyan独立筛选和提取。共有19项研究符合条件（9项针对EpCAM，9项针对CD44，2项针对EpCAM和CD44两者），共纳入1370例患者。诊断性荟萃分析显示EpCAM具有中等准确性（AUC，95%CI为0.802，0.69 - 0.96）。发现CD44表达与T分期（OR = 2.04，95%CI = 1.18 - 3.51）、或N分期（OR = 2.68，95%CI = 1.86 - 3.85）、或TNM分期（OR = 3.79，95%CI = 2.14 - 6.71）之间存在统计学显著关联。CD44v6过表达预示着更差的总生存期（HR = 2.33，p < 0.00001），而EpCAM + CD44 + 共表达具有预后意义（HR = 2.02，p = 0.02）。在所纳入的研究中未观察到异质性，但仍需进一步研究以更好地理解这些标志物阳性在PC诊断和预后中的临床意义。
