前列腺影像报告和数据系统结合PSA密度对临床显著性前列腺癌诊断价值的Meta分析

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摘要目的：采用Meta分析方法综合评价前列腺影像报告和数据系统（PI-RADS）评分结合PSA密度
（PSAD）对临床显著性前列腺癌（CSPCA）的诊断价值，为临床决策提供循证医学依据。方法：计算机检索PubMed、Embase、EBSCO、Cochrane Library、CNKI、CBM、维普数据库自建库以来至2018年9月30日国内、外公开发表的关于PI-RADS评分结合PSAD应用于前列腺癌诊断的中、英文文献。由2位评价员根据纳入与排除标准独立筛选文献、提取资料，并采用QUADAS进行质量评价和Stata10.0软件进行Meta分析，提取相关参数。结果：共纳入符合标准文献6篇，纳入患者总例数1 228例，应用Q检验和I2进行异质性分析发现文献无异质性，采用固定效应模型分析。PI-RADS对CSPCA的诊断价值的敏感度为81.1%（95%CI=0.639～0.912），特异度为82.1%（95%CI=0.694～0.903），诊断试验比值比为19.711（95%CI=6.953～55.927），阳性似然比为4.533（95%CI=2.552～8.054），阴性似然比为0.229（95%CI=0.113～0.468），评估诊断模型准确性指标Lambda为3.011（95%CI=1.967～4.054）。PI-RADS+PSAD对CSPCA的诊断价值的敏感度为87.9%（95%CI=0.826～0.917），特异度为81.8%（95%CI=0.590～0.872），诊断试验比值比为22.688（95%CI=7.403～69.538），阳性似然比为3.632（95%CI=1.941～6.800），阴性似然比为0.160（95%CI=0.095～0.270），Lambda值为3.778（95%CI=2.537～5.020）。PI-RADS+PSAD诊断的Lambda值、敏感度明显高于PI-RADS（P＜0.05)。结论：PI-RADS+PSAD可有效提高CSPCA的诊断效能。

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	方权

关键词 ： PSA密度, 前列腺癌, PI-RADS, Meta分析

Abstract：Objective: To systematically review the diagnostic value of prostate imaging reporting and data system (PI-RADS ) plus PSA density (PSAD) in clinically significant prostate cancer (CSPCA) by meta-analysis so as to provide evidence-based information for clinical. Methods: We electronically searched databases from inception to Sep 30, 2018, including PubMed, Embase, EBSCO, Cochrane Library, CNKI, CBM, and VIP to collect Chinese and English diagnostic articles on combined of PI-RADS and PSAD for CSPCA published in China and abroad. Two reviewers independently screened literature and extracted data. The included articles were assessed in term of methodological quality by QUADAS tool and analyzed with meta software in Stata10.0, then the relevant parameters were extracted. Results: A total of 6 articles met the inclusion criteria, 1 228 patients were included. The fixed effect model was used for lack of heterogeneity confirmed by Q and I2 test. The pooled sensitivity of PI-RADS for CSPCA was 81.1% [95%CI: 0.639-0.912], and the specialty, DOR, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and Lambda value were 82.1% [95%CI: 0.694-0.903], 19.711 [95%CI: 6.953-55.927], 4.533 [95%CI: 2.552-8.054], 0.229 [95%CI: 0.113-0.468] and 3.011 [95%CI: 1.967-4.054] respectively. The specialty, DOR, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and Lambda value were 87.9% [95%CI: 0.826-0.917], 81.8% [95%CI: 0.590-0.872], 22.688 [95%CI: 7.403-69.538], 3.632 [95%CI: 1.941-6.800], 0.160 [95%CI: 0.095-0.270] and 3.778 [95%CI: 2.537-5.020] for PI-RADS plus PSAD. The Lambda and sensitivity of PI-RADS plus PSAD were significantly higher than those of PI-RADS (P<0.05). Conclusion: PI-RADS plus PSAD could effectively improve the diagnosis efficiency for CSPCA.

Key words： PSA density prostate cancer PI-RADS Meta-analysis

收稿日期: 2018-12-26

作者简介: 方权（1977-），男，浙江义乌人，副主任医师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I9/681

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