The accuracy of screening technologies for liver cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YAN Yongfeng ¹ , WANG Yuting ² , ZHU Chen ³ , ZHU Jian ¹ , FAN Chunsun ¹ , BAI Fangzhou ⁴ , LU Jianquan ¹ , DU Lingbin ³ , REN Jiansong ⁴ , ZHAO Jianjun ^4,5 ,  CHEN Taoyang ¹ ,  QU Chunfeng ² ,  SHI Jufang ⁴

1. Department of Etiology, Qidong People’s Hospital and Qidong Liver Cancer Institute, Qidong, Jiangsu, 226200, P.R.China;
2. State Key Laboratory of Molecular Oncology/Department of Immunology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100021, P.R.China;
3. Zhejiang Provincial Office for Cancer Prevention, Zhejiang Cancer Center, Zhejiang Cancer Hospital, Hangzhou, 310022, P.R.China;
4. Office of Cancer Screening, National Cancer Center/Cancer Hospital, CAMS & PUMC, Beijing, 100021, P.R.China;
5. Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, CAMS & PUMC, Beijing, 100021, P.R.China;

Corresponding author：

CHEN Taoyang, Email: ty110@263.net; QU Chunfeng, Email: quchf@cicams.ac.cn; SHI Jufang, Email: shijf@cicams.ac.cn

Keywords：

Liver cancer; Alpha-Fetoprotein; Ultrasonography; Screening; Diagnostic test; Meta-analysis

DOI：

10.7507/1672-2531.201802055

Video：

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ObjectivesTo evaluate the accuracy of liver cancer screening techniques to inform screening intervention and early diagnosis.MethodsWe searched PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data, CBM, VIP databases to collect relevant diagnostic accuracy studies of screening technologies for liver cancer from January 1980 to December 2017. Two reviewers independently screened the literature, extracted the data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Meta-Disc 1.4 software.ResultsA total of 54 publications with 47 728 individuals were included. In terms of pooled sensitivity from the meta-analysis, it was estimated as 0.71 (95%CI 0.70 to 0.72), 0.57 (95%CI 0.56 to 0.59) and 0.43 (95%CI 0.41 to 0.45); the pooled specificity was estimated as 0.92 (95%CI 0.92 to 0.93), 0.95 (95%CI 0.94 to 0.96) and 0.95 (95%CI 0.94 to 0.96); the pooled positive likelihood ratio was 5.65 (95%CI 4.37 to 7.30), 13.24(95%CI 4.25 to 41.22) and 11.39 (95%CI 4.01 to 32.35); the pooled negative likelihood ratio was 0.35 (95%CI 0.31 to 0.39), 0.38 (95%CI 0.29 to 0.52) and 0.49 (95%CI 0.39 to 0.62); the diagnosis odds ratio was 17.23 (95%CI 12.26 to 24.20), 33.79 (95%CI 12.65 to 90.24) and 24.41(95%CI 9.23 to 64.53) for AFP alone with cut-off of 20, 200 and 400 ng/mL, respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.65 (95%CI 0.62 to 0.69), 0.97 (95%CI 0.97 to 0.97), 16.48 (95%CI 9.55 to 28.42), 0.27 (95%CI 0.18 to 0.42) and 64.54 (95%CI 30.16 to 138.11) for ultrasound examination alone. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.96 (95%CI 0.94 to 0.98), 0.96 (95%CI 0.96 to 0.96), 10.76 (95%CI 2.62 to 44.27), 0.07 (95%CI 0.02 to 0.22) and 160.59 (95%CI 31.61 to 816.03) for the combined strategy.ConclusionFor liver cancer screening technologies, the overall accuracy of serum AFP test alone is the optimum at cut-off of 20 ng/mL, and the sensitivity increased substantially when combined with ultrasound examination.

Citation： YAN Yongfeng, WANG Yuting, ZHU Chen, ZHU Jian, FAN Chunsun, BAI Fangzhou, LU Jianquan, DU Lingbin, REN Jiansong, ZHAO Jianjun, CHEN Taoyang, QU Chunfeng, SHI Jufang. The accuracy of screening technologies for liver cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(5): 418-427. doi: 10.7507/1672-2531.201802055 Copy

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3. 陈建国, 张永辉, 朱健, 等, 启东肝癌的早诊早治及筛查效果评价. 中华肿瘤杂志, 2017, 39(12): 946-951.
4. Jin J, Zhang XY, Shi JL, et al. Application of AFP whole blood one-step rapid detection kit in screening for HCC in Qidong. Am J Cancer Res, 2017, 7(6): 1384-1388.
5. Daniele B, Bencivenga A, Megna AS, et al. Alpha-fetoprotein and ultrasonography screening for hepatocellular carcinoma. Gastroenterology, 2004, 127(5 Suppl 1): S108-S112.
6. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 158(8): 529-536.
7. 韩笑, 张喜平, 魏子妤. 甲胎蛋白、α-L-岩藻糖苷酶、糖类抗原 199 在原发性肝癌早期筛查中的作用. 内蒙古医科大学学报, 2017, 39(2): 124-127.
8. 卢伟强, 梁辉龙. B 超联合甲胎蛋白检查提高肝癌高危人群的筛查效果. 华夏医学, 2017, 30(1): 70-73.
9. Ungtrakul T, Mahidol C, Chun-on P, et al. Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area. World J Gastroenterol, 2016, 22(34): 7806-7812.
10. 沈聪龙, 郑丽萍. 血清 PIVKA-Ⅱ、AFP 联合检测在肝癌诊断中的应用. 中国现代医生, 2016, 54(19): 21-23.
11. 宫英博, 李立文. 血清 AFP、AFU、GP73 及 SF 联合检测在原发性肝癌早期诊断中应用价值分析. 标记免疫分析与临床, 2016, 23(6): 651-654.
12. 张雪, 刘文毅, 陈尘. 血清 3 项肿瘤标志物联合检测对原发性肝癌的诊断意义分析. 数理医药学杂志, 2016, 29(8): 1148-1150.
13. Rino AG, Maulana S, Irsan H, et al. Performance of alpha fetoprotein in combination with alpha-1-acid glycoprotein for diagnosis of hepatocellular carcinoma among liver cirrhosis patients. Acta Med Indones, 2015, 47(3): 216-222.
14. Chang TS, Wu YC, Tung SY, et al. Alpha-fetoprotein measurement benefits hepatocellular carcinoma surveillance in patients with cirrhosis. Am J Gastroenterol, 2015, 110(6): 836-844.
15. 王甲甲, 张娟, 钟佳伶, 等. AFP、GP73 及 TSGF 联合检测对原发性肝癌的诊断价值. 国际检验医学杂志, 2015, 36(18): 2620-2621, 2624.
16. 秦西平, 程风春. GP73 与 AFP 联合检测在原发性肝癌早期诊断中的价值. 山东医药, 2015, 55(6): 69-70.
17. 刘首明, 夏慧, 夏清华, 等. 原发性肝癌 AFPAFU、TSGF 及 SF 检测的意义. 现代诊断与治疗, 2015, 26(8): 1836-1837.
18. Sarwar S, Khan AA, Tarique S. Validity of alpha fetoprotein for diagnosis of hepatocellular carcinoma in cirrhosis. J Coll Physicians Surg Pak, 2014, 24(1): 18-22.
19. 朱陈, 孙源源, 金燕. 血清甲胎蛋白、γ-谷氨酰转肽酶Ⅱ、高尔基体蛋白 73 检测在原发性肝癌早期诊断中的价值. 临床肝胆病杂志, 2014, 30(10): 1064-1066.
20. 徐向勇, 刘显畅, 李正峰, 等. 高尔基体蛋白联合甲胎蛋白检测在原发性肝癌早期诊断中的价值. 中国医药导报, 2014, 11(1): 83-85.
21. 盛燕军. 原发性肝癌患者血清 AFP、CEA、CA199 水平变化的特异度、敏感度分析. 浙江中医药大学学报, 2014, 38(6): 746-748.
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Chinese Journal of Evidence-Based Medicine

The accuracy of screening technologies for liver cancer: a meta-analysis

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