术前预测子宫内膜癌淋巴结转移的临床生物标志物的诊断准确性：系统评价和荟萃分析。,The Oncologist

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术前预测子宫内膜癌淋巴结转移的临床生物标志物的诊断准确性：系统评价和荟萃分析。
The Oncologist ( IF 4.8 ) Pub Date : 2019-06-11 , DOI: 10.1634/theoncologist.2019-0117
Casper Reijnen _{1,

2} , Joanna IntHout ₃ , Leon F A G Massuger ₄ , Fleur Strobbe ₄ , Heidi V N Küsters-Vandevelde ₅ , Ingfrid S Haldorsen _{6,

7} , Marc P L M Snijders ₂ , Johanna M A Pijnenborg ₄

Affiliation

背景技术在子宫内膜癌（EC）中，术前分类基于组织病理学标准，对于淋巴结转移（LNM）的风险仅具有中等诊断性能。迄今为止，尚未评估现有的分子分类系统来预测LNM。国际指南建议的临床生物标记物的优化使用可能是改善定制治疗的第一步，等待未来的分子生物标记物。目的确定术前临床生物标志物对子宫内膜癌LNM预测的诊断准确性。方法根据流行病学观察性研究（MOOSE）指南的荟萃分析，进行了系统的综述。在MEDLINE和EMBASE中鉴定的研究是由两名独立的审阅者选择的。包括的生物标志物基于推荐的指导原则（癌症抗原125 [Ca-125]，磁共振成像，计算机断层扫描和18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描[18FDG PET-CT]上的淋巴结病）或通过身体检查获得（身体质量指数，宫颈细胞学，血细胞计数）。合并的敏感性，特异性，曲线下面积（AUC）和似然比是通过双变量随机效应荟萃分析计算的。可能性比分为小（0.5-1.0或1-2.0），中（0.2-0.5或2.0-5.0）或大（0.1-0.2或≥5.0）影响。结果纳入了83项研究，包括18,205例患者。Ca-125升高和血小板增多与LNM风险的中度升高有关。淋巴结肿大在影像学上有较大增加。正常Ca-125，细胞学，18FDG PET-CT上无淋巴结肿大伴有轻度下降。这些生物标志物的AUC高于0.75。其他生物标志物的AUC <0.75，且仅产生很小的影响。结论Ca-125，血小板增多和影像学检查对LNM的风险有大而中等的影响，可以改善术前风险分层。实践的意义临床早期子宫内膜癌的常规淋巴结清扫术并不能改善预后，并且与15％-20％的手术相关发病率相关，强调需要改善术前风险分层。新的分子分类系统正在出现，但尚未进行淋巴结转移预测的评估。本文提供了国际指南推荐的所有临床生物标志物诊断性能的全面概述。

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Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis.

BACKGROUND In endometrial carcinoma (EC), preoperative classification is based on histopathological criteria, with only moderate diagnostic performance for the risk of lymph node metastasis (LNM). So far, existing molecular classification systems have not been evaluated for prediction of LNM. Optimized use of clinical biomarkers as recommended by international guidelines might be a first step to improve tailored treatment, awaiting future molecular biomarkers. AIM To determine the diagnostic accuracy of preoperative clinical biomarkers for the prediction of LNM in endometrial cancer. METHODS A systematic review was performed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies identified in MEDLINE and EMBASE were selected by two independent reviewers. Included biomarkers were based on recommended guidelines (cancer antigen 125 [Ca-125], lymphadenopathy on magnetic resonance imaging, computed tomography, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography [18FDG PET-CT]) or obtained by physical examination (body mass index, cervical cytology, blood cell counts). Pooled sensitivity, specificity, area under the curve (AUC), and likelihood ratios were calculated with bivariate random-effects meta-analysis. Likelihood ratios were classified into small (0.5-1.0 or 1-2.0), moderate (0.2-0.5 or 2.0-5.0) or large (0.1-0.2 or ≥ 5.0) impact. RESULTS Eighty-three studies, comprising 18,205 patients, were included. Elevated Ca-125 and thrombocytosis were associated with a moderate increase in risk of LNM; lymphadenopathy on imaging with a large increase. Normal Ca-125, cytology, and no lymphadenopathy on 18FDG PET-CT were associated with a moderate decrease. AUCs were above 0.75 for these biomarkers. Other biomarkers had an AUC <0.75 and incurred only small impact. CONCLUSION Ca-125, thrombocytosis, and imaging had a large and moderate impact on risk of LNM and could improve preoperative risk stratification. IMPLICATIONS FOR PRACTICE Routine lymphadenectomy in clinical early-stage endometrial carcinoma does not improve outcome and is associated with 15%-20% surgery-related morbidity, underlining the need for improved preoperative risk stratification. New molecular classification systems are emerging but have not yet been evaluated for the prediction of lymph node metastasis. This article provides a robust overview of diagnostic performance of all clinical biomarkers recommended by international guidelines. Based on these, at least measurement of cancer antigen 125 serum level, assessment of thrombocytosis, and imaging focused on lymphadenopathy should complement current preoperative risk stratification in order to better stratify these patients by risk.

更新日期：2019-11-01

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