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

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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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1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and mortality worldwide: IARC cancer base No.11. Lyon, France: IARC Press, 2013. Available at: http://globocan.iarc.fr.
2. 陳萬青, 孫可欣, 鄭榮壽, 等. 2014 年中國分地區惡性腫瘤發病和死亡分析. 中國腫瘤, 2018, 27(1): 1-14.
3. 陳建國, 張永輝, 朱健, 等, 啟東肝癌的早診早治及篩查效果評價. 中華腫瘤雜志, 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. 韓笑, 張喜平, 魏子妤. 甲胎蛋白、α-L-巖藻糖苷酶、糖類抗原 199 在原發性肝癌早期篩查中的作用. 內蒙古醫科大學學報, 2017, 39(2): 124-127.
8. 盧偉強, 梁輝龍. B 超聯合甲胎蛋白檢查提高肝癌高危人群的篩查效果. 華夏醫學, 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. 沈聰龍, 鄭麗萍. 血清 PIVKA-Ⅱ、AFP 聯合檢測在肝癌診斷中的應用. 中國現代醫生, 2016, 54(19): 21-23.
11. 宮英博, 李立文. 血清 AFP、AFU、GP73 及 SF 聯合檢測在原發性肝癌早期診斷中應用價值分析. 標記免疫分析與臨床, 2016, 23(6): 651-654.
12. 張雪, 劉文毅, 陳塵. 血清 3 項腫瘤標志物聯合檢測對原發性肝癌的診斷意義分析. 數理醫藥學雜志, 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, 張娟, 鐘佳伶, 等. AFP、GP73 及 TSGF 聯合檢測對原發性肝癌的診斷價值. 國際檢驗醫學雜志, 2015, 36(18): 2620-2621, 2624.
16. 秦西平, 程風春. GP73 與 AFP 聯合檢測在原發性肝癌早期診斷中的價值. 山東醫藥, 2015, 55(6): 69-70.
17. 劉首明, 夏慧, 夏清華, 等. 原發性肝癌 AFPAFU、TSGF 及 SF 檢測的意義. 現代診斷與治療, 2015, 26(8): 1836-1837.
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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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