流式细胞术检测DNA倍体数对鉴别良恶性肿瘤价值的Meta分析

摘要

目的：探讨流式细胞术（FCM）检测DNA倍体数在良恶性肿瘤鉴别中的应用价值，为临床恶性肿瘤诊断手段的选择提供理论依据。方法由2位研究者独立完成文献筛选，并依据纳入和排除标准，对检索到的所有文献进行二次筛选。使用Meta⁃DiSc 1.4对纳入研究的文献数据进行分析，包括异质性检验、敏感度、特异度、诊断比值比（DOR）及受试者工作特征曲线（SROC）等。结果经初筛、补充及二次筛选，共12篇文献纳入研究，包括1340例研究对象，其中恶性肿瘤组516例，良性对照组824例。异质性检验结果显示：灵敏度对数与（1-特异度）对数的Spearman相关系数为-0.343，P=0.275，不存在阈值效应。DOR曲线提示：Cochran⁃Q=26.49，P=0.0055，表明存在非阈值效应引起的异质性。采用随机效应模型计算合并统计量：敏感度为0.72（95%CI：0.68~0.76，I2=50.1%）；特异度为0.84（95%CI：0.81~0.86，I2=65.5%）。绘制DNA倍体数检测良恶性肿瘤的SROC曲线，结果显示：AUC=0.8453，Q*=0.7768。结论 FCM检测DNA异倍体对诊断恶性肿瘤具有较高的准确性，可作为临床良恶性肿瘤鉴别的一项重要辅助手段。%Objective To evaluate the application value of DNA ploidy detection using flow cytometry method(FCM)in malignant tumor identifi⁃cation,so as to provide the theoretical basis for the clinical diagnosis of malignant tumors. Methods Two researchers finished the literature screen⁃ing independently,and all the literatures were given the secondary screening according to the inclusion and exclusion criteria. The included literature data was analyzed by Meta⁃DiSc 1.4,including heterogeneity test,sensitivity,specificity,diagnostic odds ratio(DOR)and summary receiver operat⁃ing characteristic(SROC)etc. Results Totally 12 literatures were included in the study finally,including a total of 1 340 subjects consisting of 516 cases with malignant tumor and 824 cases with benign tumor. Heterogeneity inspection results showed that the Spearman correlation coefficient of sensitivity logarithm and(1-specificity)logarithm was-0.343 and there was no threshold effect(P=0.275). DOR curves was Cochran⁃Q=26.49 (P=0.005 5),indicating the heterogeneity was caused by non threshold effects. Combined statistical quantity was calculated with a random effects model and the results were as followings:the sensitivity was 0.72(95%CI:0.68⁃0.76,I2=50.1%)and the specificity 0.84(95%CI:0.81⁃0.86,I2=65.5%). SROC curve drawing,DNA ploidy detection of benign and malignant tumors showed AUC=0.845 3 and Q*=0.776 8. Conclusion FCM DNA heteroploid has a high accuracy for diagnosis of malignant tumor,which can be an important supporting means for the discrimination between benign and malignant tumor.