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Davenport CF, Rai N, Sharma P, Deeks J, Berhane S, Mallett S, Saha P, Solanki R, Bayliss S, Snell K, Sundar S. Diagnostic Models Combining Clinical Information, Ultrasound and Biochemical Markers for Ovarian Cancer: Cochrane Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:3621. [PMID: 35892881 PMCID: PMC9332683 DOI: 10.3390/cancers14153621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Ovarian cancer (OC) is a diagnostic challenge, with the majority diagnosed at late stages. Existing systematic reviews of diagnostic models either use inappropriate meta-analytic methods or do not conduct statistical comparisons of models or stratify test performance by menopausal status. Methods: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, CDSR, DARE, Health Technology Assessment Database and SCI Science Citation Index, trials registers, conference proceedings from 1991 to June 2019. Cochrane collaboration review methods included QUADAS-2 quality assessment and meta-analysis using hierarchical modelling. RMI, ROMA or ADNEX at any test positivity threshold were investigated. Histology or clinical follow-up was the reference standard. We excluded screening studies, studies restricted to pregnancy, recurrent or metastatic OC. 2 × 2 diagnostic tables were extracted separately for pre- and post-menopausal women. Results: We included 58 studies (30,121 patients, 9061 cases of ovarian cancer). Prevalence of OC ranged from 16 to 55% in studies. For premenopausal women, ROMA at a threshold of 13.1 (+/−2) and ADNEX at a threshold of 10% demonstrated significantly higher sensitivity compared to RMI I at 200 (p < 0.0001) 77.8 (72.5, 82.4), 94.9 (92.5, 96.6), and 57.1% (50.6 to 63.4) but lower specificity (p < 0.002), 92.5 (90.0, 94.4), 84.3 (81.3, 86.8), and 78.2 (75.8, 80.4). For postmenopausal women, ROMA at a threshold of 27.7 (+/−2) and AdNEX at a threshold of 10% demonstrated significantly higher sensitivity compared to RMI I at a threshold of 200 (p < 0.001) 90.4 (87.4, 92.7), 97.6 (96.2, 98.5), and 78.7 (74.3, 82.5), specificity of ROMA was comparable, whilst ADneX was lower, 85.5 (81.3, 88.9), 81.3 (76.9, 85.0) (p = 0.155), compared to RMI 55.2 (51.2, 59.1) (p < 0.001). Conclusions: In pre-menopausal women, ROMA and ADNEX offer significantly higher sensitivity but significantly decreased specificity. In post-menopausal women, ROMA demonstrates significantly higher sensitivity and comparable specificity to RMI I, ADNEX has the highest sensitivity of all models, but with significantly reduced specificity. RMI I has poor sensitivity compared to ROMA or ADNEX. Choice between ROMA and ADNEX as a replacement test will depend on cost effectiveness and resource implications.
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Affiliation(s)
- Clare F. Davenport
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; (P.S.); (J.D.); (S.B.); (S.B.)
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham B15 2TT, UK
| | - Nirmala Rai
- Southend University Hospital NHS Trust, Southend-on-Sea SS0 0RY, UK;
| | - Pawana Sharma
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; (P.S.); (J.D.); (S.B.); (S.B.)
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham B15 2TT, UK
| | - Jon Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; (P.S.); (J.D.); (S.B.); (S.B.)
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham B15 2TT, UK
| | - Sarah Berhane
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; (P.S.); (J.D.); (S.B.); (S.B.)
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham B15 2TT, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London NW1 2BU, UK;
| | - Pratyusha Saha
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Rita Solanki
- Nuffield Division of Clinical Laboratory Sciences, John Radcliffe Hospital, Oxford OX3 9DU, UK;
| | - Susan Bayliss
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; (P.S.); (J.D.); (S.B.); (S.B.)
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham B15 2TT, UK
| | - Kym Snell
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele ST5 5BG, UK;
| | - Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B187QH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B152TT, UK
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Hua J, Liu J, Hua M, Cai R, Li M, Wang J, Wang J. Diagnostic performance of biomarkers for ovarian cancer: Protocol for an overview, evidence mapping, and adjusted indirect comparisons. Medicine (Baltimore) 2019; 98:e15508. [PMID: 31045839 PMCID: PMC6504260 DOI: 10.1097/md.0000000000015508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Ovarian cancer is one of the deadliest gynecological diseases and the annual mortality of ovarian cancer continues to rise. The prognosis of ovarian cancer is poor because it is prone to early metastasis during progression. Therefore, early diagnosis of ovarian cancer is very important. Some systematic reviews have evaluated the diagnostic value of different biomarkers for ovarian cancer. However, there is no consensus in the conclusions, and some are even contradictory. This study aims to assess the methodological and reporting quality of available systematic reviews and to find an optimal biomarker for diagnosing ovarian cancer. METHODS The PubMed, Embase.com, the Cochrane Library of Systematic Reviews, and Web of Science were searched to identify relevant systematic reviews from inception to February 2019. We included systematic reviews that include randomized controlled trials, cross-sectional studies, case-control studies, or cohort studies as long as the systematic reviews evaluated the diagnostic performance of biomarkers for ovarian cancer. The methodological quality will be assessed using assessment of multiple systematic reviews-2 checklist, and the reporting quality will be assessed using preferred reporting items for systematic reviews and meta-analysis diagnostic test accuracy (PRISMA-DTA) checklist. The pairwise meta-analysis and indirect comparisons will be performed using STATA (13.0; Stata Corporation, College Station, TX). RESULTS The results of this overview will be submitted to a peer-reviewed journal for publication. CONCLUSION This overview will provide comprehensive evidence of different biomarkers for diagnosing ovarian cancer. PROSPERO REGISTRATION NUMBER CRD42019125880.
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Affiliation(s)
- Jinyong Hua
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou
| | - Jing Liu
- Public People's Hospital of Xinzheng, Xinzheng
| | - Mengge Hua
- Public People's Hospital of Xinzheng, Xinzheng
| | - Runjin Cai
- The Second Clinical Medical College of Lanzhou University
| | - Muyang Li
- The Second Clinical Medical College of Lanzhou University
| | - Jing Wang
- Department of Obstetrics and Gynecology, First Hospital of Lanzhou University
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