{"title":"结合血清甲胎蛋白、PIVKA-Ⅱ和glypican-3诊断肝细胞癌：一项荟萃分析。","authors":"Hongliang Song, Jianguo Wang, Hui Zhang, Yongfeng Wu, Kai Wang, Xiaobo Wang, Xiao Xu","doi":"10.3724/zdxbyxb-2023-0483","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To assess the value of serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) and glypican-3 (GPC-3) in the diagnosis of hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>Studies of AFP, PIVKA-Ⅱ, GPC-3 or in combination for the diagnosis of HCC since 2002 were searched in PubMed, Web of Science and Embase databases. The literature was screened according to the inclusion and exclusion criteria, the quality of the included articles was evaluated by QUADAS checklist, and relevant data were extracted by Meta DiSc, Review Manager 5.4 and Stata 15.1. The diagnostic values of AFP, PIVKA-Ⅱ and GPC-3 alone or in combination for HCC were assessed with receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>A total of 32 articles were included in the study. Meta-analysis showed that when a single marker was used to diagnose HCC, the area under the ROC curve (AUC) of PIVKA-Ⅱ was the highest (0.88, 95%<i>CI</i>: 0.85-0.91), followed by GPC-3 and AFP. The AUC of combination of serum markers was higher than that of a single marker, and the AUC of PIVKA-Ⅱ combined with GPC-3 was the highest (0.90, 95%<i>CI</i>: 0.87-0.92). When a single marker was used for diagnosis, the sensitivity of PIVKA-Ⅱ and GPC-3 were relatively high (0.75 and 0.76), while the specificity of PIVKA-Ⅱ (0.88) and AFP (0.87) were higher than that of GPC-3 (0.81). The sensitivity of the combination of serum markers was higher than that of a single marker, while the specificity was not significantly improved. When a single marker is used to diagnose HCC, the diagnostic odds ratio (DOR) of PIVKA-Ⅱ was the highest (22, 95%<i>CI</i>: 13-36), followed by GPC-3 and AFP. The DOR of the combination of two markers in the diagnosis of HCC was higher than that of a single marker, and the DOR of AFP combined with GPC-3 was the highest (25, 95%<i>CI</i>: 9-67). The DOR of the combination of the three markers was significantly reduced to 10 (95%<i>CI</i>: 7-45).</p><p><strong>Conclusions: </strong>When a single marker is used, PIVKA-Ⅱ has a higher diagnostic value for HCC. The combination of two markers can significantly improve the diagnostic sensitivity, and AFP combined with PIVKA-Ⅱ is recommended for the diagnosis of HCC. The combination of all three markers failed to further improve the diagnostic value.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945496/pdf/","citationCount":"0","resultStr":"{\"title\":\"Combination of serum alpha-fetoprotein, PIVKA-Ⅱ and glypican-3 in diagnosis of hepatocellular carcinoma: a meta-analysis.\",\"authors\":\"Hongliang Song, Jianguo Wang, Hui Zhang, Yongfeng Wu, Kai Wang, Xiaobo Wang, Xiao Xu\",\"doi\":\"10.3724/zdxbyxb-2023-0483\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To assess the value of serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) and glypican-3 (GPC-3) in the diagnosis of hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>Studies of AFP, PIVKA-Ⅱ, GPC-3 or in combination for the diagnosis of HCC since 2002 were searched in PubMed, Web of Science and Embase databases. The literature was screened according to the inclusion and exclusion criteria, the quality of the included articles was evaluated by QUADAS checklist, and relevant data were extracted by Meta DiSc, Review Manager 5.4 and Stata 15.1. The diagnostic values of AFP, PIVKA-Ⅱ and GPC-3 alone or in combination for HCC were assessed with receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>A total of 32 articles were included in the study. Meta-analysis showed that when a single marker was used to diagnose HCC, the area under the ROC curve (AUC) of PIVKA-Ⅱ was the highest (0.88, 95%<i>CI</i>: 0.85-0.91), followed by GPC-3 and AFP. The AUC of combination of serum markers was higher than that of a single marker, and the AUC of PIVKA-Ⅱ combined with GPC-3 was the highest (0.90, 95%<i>CI</i>: 0.87-0.92). When a single marker was used for diagnosis, the sensitivity of PIVKA-Ⅱ and GPC-3 were relatively high (0.75 and 0.76), while the specificity of PIVKA-Ⅱ (0.88) and AFP (0.87) were higher than that of GPC-3 (0.81). The sensitivity of the combination of serum markers was higher than that of a single marker, while the specificity was not significantly improved. When a single marker is used to diagnose HCC, the diagnostic odds ratio (DOR) of PIVKA-Ⅱ was the highest (22, 95%<i>CI</i>: 13-36), followed by GPC-3 and AFP. The DOR of the combination of two markers in the diagnosis of HCC was higher than that of a single marker, and the DOR of AFP combined with GPC-3 was the highest (25, 95%<i>CI</i>: 9-67). The DOR of the combination of the three markers was significantly reduced to 10 (95%<i>CI</i>: 7-45).</p><p><strong>Conclusions: </strong>When a single marker is used, PIVKA-Ⅱ has a higher diagnostic value for HCC. The combination of two markers can significantly improve the diagnostic sensitivity, and AFP combined with PIVKA-Ⅱ is recommended for the diagnosis of HCC. The combination of all three markers failed to further improve the diagnostic value.</p>\",\"PeriodicalId\":24007,\"journal\":{\"name\":\"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945496/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3724/zdxbyxb-2023-0483\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3724/zdxbyxb-2023-0483","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
研究目的评估血清甲胎蛋白（AFP）、维生素K缺失或拮抗剂-Ⅱ（PIVKA-Ⅱ）诱导蛋白和甘丙三（GPC-3）在肝细胞癌（HCC）诊断中的价值：方法：在PubMed、Web of Science和Embase数据库中检索2002年以来有关AFP、PIVKA-Ⅱ和GPC-3或三者联合用于诊断HCC的研究。根据纳入和排除标准筛选文献，用 QUADAS 检查表评估纳入文章的质量，并用 Meta DiSc、Review Manager 5.4 和 Stata 15.1 提取相关数据。用接收者操作特征曲线（ROC）评估了AFP、PIVKA-Ⅱ和GPC-3单独或联合检测对HCC的诊断价值：结果：共筛选出 32 篇文章。Meta分析表明，当使用单一标记物诊断肝癌时，PIVKA-Ⅱ的ROC曲线下面积（AUC）最高（0.88，95%CI：0.85-0.91），其次是GPC-3和AFP。血清标记物组合的 AUC 高于单一标记物，其中 PIVKA-Ⅱ 与 GPC-3 组合的 AUC 最高（0.90，95%CI：0.87-0.92）。当使用单一标记物进行诊断时，PIVKA-Ⅱ和 GPC-3 的敏感性相对较高（分别为 0.75 和 0.76），而 PIVKA-Ⅱ 和 AFP 的特异性相对较高（分别为 0.88 和 0.87），高于 GPC-3 的特异性（0.81）。血清标志物组合的灵敏度高于单一标志物，但特异性没有明显提高。当使用单一标记物诊断肝癌时，PIVKA-Ⅱ的诊断几率比（DOR）最高（22，95%CI：13-36），其次是GPC-3和AFP。两种标记物联合诊断肝癌的几率比高于单一标记物，PIVKA-Ⅱ联合GPC-3的几率比最高（25，95%CI：9-67）。三个标记物组合的 DOR 明显降低到 10（95%CI：7-45）：结论：使用单一标记物时，PIVKA-Ⅱ对HCC具有更高的诊断价值。结论：当使用单一标记物时，PIVKA-Ⅱ对HCC具有更高的诊断价值，两种标记物联合使用可显著提高诊断灵敏度，建议将AFP与PIVKA-Ⅱ联合用于肝癌诊断。三种标记物的联合不能进一步提高诊断价值。
Combination of serum alpha-fetoprotein, PIVKA-Ⅱ and glypican-3 in diagnosis of hepatocellular carcinoma: a meta-analysis.
Objectives: To assess the value of serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) and glypican-3 (GPC-3) in the diagnosis of hepatocellular carcinoma (HCC).
Methods: Studies of AFP, PIVKA-Ⅱ, GPC-3 or in combination for the diagnosis of HCC since 2002 were searched in PubMed, Web of Science and Embase databases. The literature was screened according to the inclusion and exclusion criteria, the quality of the included articles was evaluated by QUADAS checklist, and relevant data were extracted by Meta DiSc, Review Manager 5.4 and Stata 15.1. The diagnostic values of AFP, PIVKA-Ⅱ and GPC-3 alone or in combination for HCC were assessed with receiver operating characteristic (ROC) curve.
Results: A total of 32 articles were included in the study. Meta-analysis showed that when a single marker was used to diagnose HCC, the area under the ROC curve (AUC) of PIVKA-Ⅱ was the highest (0.88, 95%CI: 0.85-0.91), followed by GPC-3 and AFP. The AUC of combination of serum markers was higher than that of a single marker, and the AUC of PIVKA-Ⅱ combined with GPC-3 was the highest (0.90, 95%CI: 0.87-0.92). When a single marker was used for diagnosis, the sensitivity of PIVKA-Ⅱ and GPC-3 were relatively high (0.75 and 0.76), while the specificity of PIVKA-Ⅱ (0.88) and AFP (0.87) were higher than that of GPC-3 (0.81). The sensitivity of the combination of serum markers was higher than that of a single marker, while the specificity was not significantly improved. When a single marker is used to diagnose HCC, the diagnostic odds ratio (DOR) of PIVKA-Ⅱ was the highest (22, 95%CI: 13-36), followed by GPC-3 and AFP. The DOR of the combination of two markers in the diagnosis of HCC was higher than that of a single marker, and the DOR of AFP combined with GPC-3 was the highest (25, 95%CI: 9-67). The DOR of the combination of the three markers was significantly reduced to 10 (95%CI: 7-45).
Conclusions: When a single marker is used, PIVKA-Ⅱ has a higher diagnostic value for HCC. The combination of two markers can significantly improve the diagnostic sensitivity, and AFP combined with PIVKA-Ⅱ is recommended for the diagnosis of HCC. The combination of all three markers failed to further improve the diagnostic value.
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