The Value of Circulating Tumor DNA in the Prognostic Diagnosis of Bladder Cancer: A Systematic Review and Meta-Analysis.

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Urologia Internationalis Pub Date : 2025-05-02 DOI:10.1159/000546014

Yu Lu, Huajun Wu, Jian Jiang, Siwen Bao, Chen Ling

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引用次数: 0

Abstract

Introduction: Circulating tumor DNA (ctDNA) is a noninvasive liquid biopsy technique that can reflect the dynamic changes of tumors in real time. This study aims to clarify the predictive value of ctDNA detection for disease progression and metastasis risk in bladder cancer patients through systematic review and meta-analysis, providing a scientific basis for clinicians' individualized treatment decisions and risk stratification management for patients.

Methods: Studies related to ctDNA in prognostic assessment of bladder cancer were screened by systematically searching PubMed, Cochrane Library, Web of Science, Willey library, CNKI, and other databases, and the search was from inception to December 2024, and the data were extracted and analyzed by Meta-analysis.

Results: A total of 9 papers were included, and the results showed that ctDNA testing had a sensitivity of 0.68 (95% CI: 0.54-0.78), specificity of 0.76 (95% CI: 0.51-0.90), and an area under the curve of 0.75 (95% CI: 0.71-0.79), suggesting that it has a moderate level of diagnostic efficacy in the assessment of prognosis in bladder cancer. Positive likelihood ratio and negative likelihood ratio were 2.8 (95% CI: 1.24-6.35) and 0.43 (95% CI: 0.28-0.65), respectively, with a diagnostic odds ratio of 6.56 (95% CI: 2.12-20.33). Fagan's nomogram analysis showed that when the prior probability was 50%, the posttest probability increased to 74% for positive results and decreased to 30% for negative results. Deeks' funnel plot analysis indicated no significant publication bias (p = 0.24). A high level of heterogeneity (I2 > 80%) was observed among the studies, which may stem from differences in detection techniques, disease stages of patients, and follow-up periods. Publication bias analysis revealed no significant bias (p = 0.24).

Conclusion: ctDNA demonstrates some clinical application value in the prognostic assessment of bladder cancer and can assist in predicting patient recurrence and survival. However, its independent predictive efficacy is not enough to replace traditional assessment methods. Future studies should aim to optimize the detection technology, unify the study design, expand the sample size, and combine multi-omics data for joint analysis, in order to further improve its potential application in the prognostic assessment of bladder cancer.

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循环肿瘤DNA在膀胱癌预后诊断中的价值：系统回顾和荟萃分析。

目的：本研究旨在系统评价ctDNA在膀胱癌预后评估中的临床疗效，为其在个体化治疗和风险分层管理中的应用提供依据。方法：系统检索PubMed、Cochrane Library、Web of Science、Willey Library、CNKI等数据库，筛选ctDNA在膀胱癌预后评估中的相关研究，检索时间为建库至2024年12月，提取数据并进行meta分析。采用随机效应模型计算SEN、SPE、PLR、NLR、DOR和AUC，并评估研究间的异质性和发表偏倚。结果：共纳入9篇论文，结果显示ctDNA检测的SEN为0.68 (95% CI: 0.54 ~ 0.78)， SPE为0.76 (95% CI: 0.51 ~ 0.90)， AUC为0.75 (95% CI: 0.71 ~ 0.79)，提示ctDNA检测在膀胱癌预后评估中具有中等水平的诊断效能。PLR和NLR分别为2.8 （95% CI: 1.24-6.35）和0.43 (95% CI: 0.28-0.65)， DOR为6.56 （95% CI: 2.12-20.33）。Fagan图分析显示，当先验概率为50%时，阳性结果的后验概率上升到74%，阴性结果的后验概率下降到30%。Deeks漏斗图分析无显著发表偏倚（P=0.24）。然而，研究间异质性较高（所有I²值均为bbb80 %），这可能受到检测技术、患者特征和随访时间等因素的影响。结论：ctDNA在膀胱癌的预后评估中具有一定的临床应用价值，有助于预测患者的复发和生存。但其独立的预测效果不足以取代传统的评估方法。未来的研究应优化检测技术，统一研究设计，扩大样本量，结合多组学数据进行联合分析，以进一步提高其在膀胱癌预后评估中的潜在应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologia Internationalis 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

6.20%

发文量

审稿时长

3-8 weeks

期刊介绍： Concise but fully substantiated international reports of clinically oriented research into science and current management of urogenital disorders form the nucleus of original as well as basic research papers. These are supplemented by up-to-date reviews by international experts on the state-of-the-art of key topics of clinical urological practice. Essential topics receiving regular coverage include the introduction of new techniques and instrumentation as well as the evaluation of new functional tests and diagnostic methods. Special attention is given to advances in surgical techniques and clinical oncology. The regular publication of selected case reports represents the great variation in urological disease and illustrates treatment solutions in singular cases.