| Objective:To systematically review the diagnosis and treatment ofThyroid Stimulating Hormone(TSH),Thyroglobulin Antibodies(TgAb),and Thyroid Peroxidase Antibodies(TPOAb)for Thyroid Cancer(TC).Methods:Pubmed,Embase,The Cochrane Library,China Biology Medicin(CBM),Chinese National Knowledge Infrastructure(CNKI),VIP and WanFang Data databases were electronically searched to collectpublished studies on serum TSH,TgAb,TPOAb,benign and malignant thyroid nodules from inception to October,2019.Two reviewers independently screened literature,extracted data and assessed the risk ofbias and quality of included studies,then,meta-analysis was performed by using meta-disc 1.4,Stata16.0,and RevMan5.3 software.Results:1.A total of 46 studies involving 23059 patients related to serum TSH with TC were included.The result of meta-analysis showed that there washeterogeneity among the results(I2=96.5%).The random effectmodel was adopted and it was showed that,the TSH level of TC group was significantly higher than the Benign Thyroid Nodule(BTN)group[Standard Mean Difference(SMD)=0.85,95%Confidence Interval(CI)0.69 to 1.02,P=0.000].The correlation between serum TSH level and tumor size,lymph node metastasis,TNM stage in the included studies was analyzed.The meta-analysis showed the following results:the Serum TSH level in the tumor diameter>1 cm group is higher than the tumor diameter<1 cmgroup(SMD=0.27,95%CI 0.14 to 0.41,P=0.000);the tumor metastaticlymph node group is higher than without lymph node metastasis group(SMD=0.51,95%CI 0.19 to 0.82,P=0.002);?-? stage group is higher than ?-? stage group in the TNM staging(SMD=1.07,95%CI 0.39 to 1.74,P=0.002).Seven of these studies analyzed the diagnostic value of serum TSHto Papillary Thyroid Microcarcinoma(PTMC).The meta-analysis consistency test showed there was no heterogeneity and the fixed effectmodel,the serum TSH level of in PTMC group was higher than that in BTN group(SMD=0.12,95%CI 0.03 to 0.21,P=0.011).2.A total of 51 studies involving 42379 patients related to serum TgAb with TC were included.The result of meta-analysis showed that there was heterogeneity among the results(I2=65.6%).The random effectmodel showed that the positive rate of TgAb in TC group was higher than that in BTN group[Odds Ratio(OR)=2.48,95%CI 2.22 to 2.76,P=0.011].Sensitivity(Sen)=0.25,95%CI 0.23 to 0.28;Specificity(Spe)=0.88,95%CI 0.87 to 0.90;Positive likehood ratio(+LR)=2.04,95%CI 1.88 to 2.23;Negative likehood ratio(-LR)-0.85,95%CI 0.83 to 0.87;The area under the SROC curve AUC=0.60,95%CI 0.56 to 0.65,and Q*index=0.57.A total of 7 studies analyzed the correlation between TgAb positivity and lymph node metastasis.The result of meta-analysis showed that there washeterogeneity among the results(I2=75.1%).By using the random effect model the result can be showed that Lymph node metastasis is more common in TC patients whose TgAb is positive(OR=2.26,95%CI 1.42 to 3.59,P=0.0005).3.A total of 34 articles involving 30291 patients related to the diagnostic value of serum TPOAb with TC were included.The meta-analysis showed that there was heterogeneity among the results(I2=78.7%).The random effect model was adopted and the results showed that the positive rate of TPOAb in TC group was higher than that in BTN group(OR=2.09,95%CI 1.76 to 2.49,P=0.000).Sen=0.22,95%CI 0.18 to 0.26;Spe=0.88,95%CI 0.86 to 0.90;+LR=1.82,95%CI 1.58 to 2.09;-LR=0.89,95%CI 0.87 to 0.92;The area AUC under the SROC curve AUC=0.64,95%CI 0.58 to 0.67,and Q*index=0.61.Conclusion:1.Serum TSH level can be used as an independent risk factor for TC,which is related to tumor diameter,tumor lymph node metastasis and TNM stage;The TSH level of PTMC group was higher than that of BTN group.2.Serum TgAb positive can serve as an independent risk factor for TC,and Lymph node metastasis was more commonin TC patients with positive TgAb.3.Serum TPOAb positive can be regarded as an independent risk factor for TC. |
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