Abstract
BackgroundMutant p53 protein overexpression has been reported to induce serum antibodies against p53. Various studies assessing the diagnostic value of serum p53 antibody in patients with esophageal cancer remain controversial. This study aims to comprehensively and quantitatively summarize the potential diagnostic value of serum p53 antibody in esophageal cancer.MethodsWe systematically searched PubMed and Embase until 31st May 2012, without language restriction. Studies were assessed for quality using QUADAS (quality assessment of studies of diagnostic accuracy). Positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were pooled separately and compared with overall accuracy measures diagnostic odds ratio (DOR) and symmetric summary receiver operating characteristic (sROC). The PLR and NLR and their 95% confidence interval (CI) were calculated using a fixed effects model according to the Mantel-Haensed method and random effects model based on the work of Der Simonian and laird, respectively.ResultsFifteen studies (cases = 1079, controls = 2260) met the inclusion criteria for the meta-analysis. Approximately 53.33% (8/15) of the included studies were of high quality (QUADAS score≥8), which were retrospective case-control studies. The summary estimates for quantitative analysis of serum p53 antibody in the diagnosis of esophageal cancer were PLR 6.95 (95% CI: 4.77–9.51), NLR 0.75 (95%CI: 0.72–0.78) and DOR 9.65 (95%CI: 7.04–13.22). However, we found significant heterogeneity between NLRs.ConclusionsThe current evidence suggests serum p53 antibody has a potential diagnostic value for esophageal cancer. However, its discrimination power is not perfect because of low sensitivity.ImpactThese results suggest that s-p53-antibody may be useful for monitoring residual tumor cells and for aiding in the selection of candidates for less invasive treatment procedures because of the high specificity of s-p53-antibody. Further studies may need to identify patterns of multiple biomarkers to further increase the power of EC detection.
Highlights
Esophageal cancer, composed of squamous cell carcinoma and adenocarcinoma, is the eighth most common cancer worldwide, constitutes 6.13% of all digestive system cancer, with 482,300 new cases annually, and has the sixth highest cancer mortality, with 406,800 deaths registered in 2008 worldwide [1]
Impact: These results suggest that s-p53-antibody may be useful for monitoring residual tumor cells and for aiding in the selection of candidates for less invasive treatment procedures because of the high specificity of s-p53-antibody
Inclusion criteria for the primary studies were as follows: (i) participants: all cases must have been diagnosed by a gold standard, serum must have been collected for anti-p53 analysis before any treatment, e.g. chemotherapy or radiotherapy, and controls were without other cancers, (ii) index test: studies evaluated the diagnostic value of s-p53 antibody in esophageal cancer, (iii) outcome: studies reported the positive values of the cases and controls, and the results of an individual study on diagnostic accuracy can be summarized in a 262 table, (iv) study design: No restrictions were made with respect to study design or data collection
Summary
Esophageal cancer, composed of squamous cell carcinoma and adenocarcinoma, is the eighth most common cancer worldwide, constitutes 6.13% of all digestive system cancer, with 482,300 new cases annually, and has the sixth highest cancer mortality, with 406,800 deaths registered in 2008 worldwide [1]. 17,460 cases of esophageal cancer are expected to be newly diagnosed in 2012, with 15,070 estimated deaths accounting for 86% of all estimated new cases [2]. During the early stages of the esophageal cancers, patients are usually asymptomatic and go undetected until they are incurable. The prognosis of this disease is unfavorable in spite of advances in therapies. If patients are diagnosed at an early stage, the overall survival could be significantly improved, with a 5-year survival rate of up to 90% [3]. Various studies assessing the diagnostic value of serum p53 antibody in patients with esophageal cancer remain controversial. This study aims to comprehensively and quantitatively summarize the potential diagnostic value of serum p53 antibody in esophageal cancer
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