循环肿瘤DNA对黑色素瘤诊断价值的Meta分析

doi:10.3969/j.issn.1673-8640.2020.08.010

摘要/Abstract

摘要：

目的通过Meta分析系统评估循环肿瘤DNA（ctDNA）对黑色素瘤中基因突变的诊断价值。方法系统检索Medline、Excerpta Medica Database（Embase）、Cochrane Library、中国知网及维普数据库,筛选出2019年1月之前发表的符合纳入标准的文献。以I²和Q检验为指标分析异质性,采用相应的模型分析合并敏感性、合并特异性、合并阳性似然比（PLR）、合并阴性似然比（NLR）、合并诊断优势比（DOR）和综合受试者工作特征曲线的曲线下面积（AUC）。采用Deeks' 漏斗图评估发表偏移。结果共纳入10项研究,涉及1 360例研究对象。合并敏感性、合并特异性、合并PLR和合并NLR分别为0.71[95%可信区间（CI）为0.63~0.79]、0.94（95%CI为0.91~0.96）、11.3（95%CI为7.2~17.5）和0.31（95%CI为0.23~0.41）。AUC和DOR分别为0.94（95%CI为0.92~0.96）和37（95%CI为19~71）。Deeks'漏斗图表明存在发表偏移。结论在黑色素瘤患者中,ctDNA具有诊断价值,有望成为黑色素瘤基因突变诊断的辅助手段。

关键词: 循环肿瘤DNA, 黑色素瘤, 诊断价值, Meta分析

Abstract:

Objective To evaluate the diagnostic value of circulating tumor DNA（ctDNA） for melanoma by a Meta-analysis. Methods Medline,Excerpta Medica Database（Embase）,Cochrane Library database,CNKI database and VIP database were searched systematically to identify studies reporting the diagnostic value of ctDNA for melanoma,until January 2019. The heterogeneity was analyzed by I² and Q tests. The pooled sensitivity,specificity,positive likelihood ratio（PLR）,negative likelihood ratio（NLR）,diagnostic odds ratio（DOR） and the area under receiver operating characteristic（ROC） curve（AUC） were analyzed. Deek's funnel plots were used to evaluate publication bias. Results A total of 10 eligible studies involving 1 360 patients were included in this Meta-analysis. The pooled sensitivity,specificity,PLR and NLR were 0.71 [95% confidence interval（CI） 0.63-0.79],0.94（95%CI 0.91-0.96）,11.3（95%CI 7.2-17.5） and 0.31（95%CI 0.23-0.41）,respectively. The AUC and DOR were 0.94（95%CI 0.92-0.96）and 37（95%CI 19-71）. Deek's funnel plots showed a publication bias. Conclusions ctDNA is potential for the auxiliary diagnosis of melanoma.

Key words: Circulating tumor DNA, Melanoma, Diagnostic value, Meta-analysis

中图分类号:

R446.1

万文婷, 于波, 弓孟春, 史文钊, 郭昊, 杨杰. 循环肿瘤DNA对黑色素瘤诊断价值的Meta分析[J]. 检验医学, 2020, 35(8): 784-790.

WAN Wenting, YU Bo, GONG Mengchun, SHI Wenzhao, GUO Hao, YANG Jie. Value of circulating tumor DNA for the diagnosis of melanoma：a Meta-analysis[J]. Laboratory Medicine, 2020, 35(8): 784-790.

图/表 7

图1 文献筛选流程图

图2 文献质量评价图注：（a）风险偏移条目和适用性总结图;（b）质量评价条形图

图3 Deeks'漏斗图注：○ 纳入文献;------ 回归线

图4 敏感性和特异性森林图

图5 ctDNA在黑色素瘤中的综合受试者工作特征曲线注：○ 纳入文献;◆ 集成操作点;— 受试者工作特征曲线; ---95%CI

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