| Objective: To systematic evaluate the diagnostic and prognostic value of microRNA-21 in the blood for digestive system tumors through meta-analysis.Methods: To collect the literatures on the diagnosis and prognosis of digestive system tumors with microRNA-21 in the blood published before during construction of the library until January 2018,We searched PubMed,Embase,Cochrane Library,Web of Science,CNKI,VIP Database,Wanfang Database and Chinese Biomedical Literature Database.The literatures were screened strictly according to inclusion and exclusion criteria,the data were extracted,QUADAS-2 and NOS quality was assessed on the included studies and Meta-analysis was finally performed on the included studies using MetaDiSc 1.4 and Stata 12.0 software.Results: A total of 33 eligible articles(35 studies)were included in diagnostic meta-analysis,including 2035 cases and 1735 controls.Using the random effect model,the pooled statistics showed that the combined sensitivity(SEN)was 0.79(95% CI:0.77~0.81),the specificity(SPE)was 0.78(95% CI: 0.76~0.80),the positive likelihood ratio(PLR)was 3.78(95% CI: 3.09~4.63),the negative likelihood ratio(NLR)was 0.25(95% CI: 0.21~0.30),the diagnostic odds ratio(DOR)was 17.96(95% CI: 12.52~25.76)and the area under the ROC curve(AUC)was 0.8792.Subgroup analyzes showed that the AUC of microRNA-21 in the blood for the diagnosis of gastric cancer,colorectal cancer,pancreatic cancer and hepatocellular cancer were 0.8767,0.8463,0.8218 and 0.9096 respectively.The AUC of microRNA-21 in the serum and plasma for the diagnosis of digestive system tumors were 0.8682 and 0.8941 respectively.The AUC of microRNA-21 in detecting digestive system tumors in Asia,Europe and the United States,Africa were0.8828,0.8709 and 0.9277 respectively.In the healthy group and benign disease + healthy group control group,the AUC of microRNA-21 in detecting digestive system tumors were0.8801 and 0.8747 respectively.A total of 13 eligible studies were included in prognostic meta-analysis,including 2035 cases and the patients with digestive system tumors thatexpress high levels of microRNA-21 in the blood have a combined overall survival(OS)hazard ratio(HR)of 1.87(95% CI: 1.14~3.06,P =0.013).Different types of digestive system tumor subgroup analysis results show that the HR of pancreatic cancer combined with OS was 2.03(95% CI: 1.47~2.79,P<0.001);but the prognosis of microRNA-21 and esophageal cancer,gastric cancer and colorectal cancer was not statistically significant.The results of subgroup analysis in different regions showed that the HR of combined OS in Asia was 2.06(95%CI: 1.17~3.62,P = 0.012);but in Europe and the United States,microRNA-21 has no statistical significance in the prognosis of patients with digestive system tumors.Conclusion:1.The microRNA-21 in the blood has a good diagnostic efficacy for digestive system tumors and it can be also used as an indicator for auxiliary diagnosis of digestive system tumors.Subgroup analysis showed that plasma microRNA-21 is more effective than serum in diagnosis of digestive system tumors;besides,microRNA-21 in the blood may be more suitable for the diagnosis of hepatocellular cancer.2.High expression of microRNA-21 in the blood may be a poor prognostic factor for patients with digestive system tumors in Asian populations;besides,microRNA-21 in the blood may be more suitable for the evaluation of prognosis in patients with pancreatic cancer. |
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