Objective  To systematically review the diagnostic value of combined detection of K-ras gene mutation in peripheral blood and serum tumor markers for pancreatic cancer. Methods  Databases including PubMed, The Cochrane Library (Issue 3, 2016), Elsevier, BMJ, CBM, CNKI and WanFang Data were searched from 2000 to March 2016 to collect diagnostic tests about the diagnostic value of combined detection of K-ras gene mutation in peripheral blood and serum tumor markers in pancreatic cancer. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results  A total of 23 studies involving 2 071 patients were included. The results of meta-analysis showed that the sensitivity (SE) and specificity (SP) of K-ras gene mutation in peripheral blood were 65% and 92% respectively in the diagnosis for pancreatic cancer. The results of the detection of tumor marker CA19-9 were 78% and 81% respectively. The SE and SP indexes in the parallel and serial combinations of CA19-9 together with CA242 were 85%, 72%, 70% and 83% respectively. And the SE, SP indexes in the parallel and serial combinations of K-ras gene mutation combined detection with CA19-9 were 90%, 63%, 47% and 96%. The positive likelihood ratio of the parallel combination of K-ras gene mutation in peripheral blood and CA19-9 (+LR=10.89) was higher than the other three detection methods, while the negative likelihood ratio of the serial combination of K-ras gene mutation in peripheral blood and CA19-9 (-LR=0.15) was lower than the other three detection methods, which indicated that the combined detection of K-ras gene mutation in peripheral blood and and CA19-9 had a better diagnostic performance than the single dectection of K-ras gene mutation or CA19-9 or the combined detection of CA19-9 and CA242 respectively. Comparing the area under curve (AUC) of SROC curve of the two combined diagnoses, the results showed that the diagnostic value of the parallel combination of K-ras gene mutation in peripheral blood and CA19-9 (AUC=0.87) was higher than that of the parallel combination of serum tumor markers CA19-9 and CA242. Conclusion  Current evidence indicates that the combined detection of K-ras gene mutation and and tumor marker CA19-9 levels in peripheral blood can improve the diagnostic accuracy for pancreatic cancer. Due to the limited quantity and quality of included studies, above conclusions need to be verified by conducting more high quality studies.

Citation： HUXin-ying, HUXiao-qing, WANGLi-na. Diagnostic Value of Combined Detection of K-ras Gene Mutation in Peripheral Blood and Serum Tumor Markers in for Pancreatic Cancer: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(6): 668-675. doi: 10.7507/1672-2531.20160104 Copy