Diagnostic value of miRNAs for pancreatic cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Yingying ,  ZHOU Xiaobin , ZHU Xiaoyan , SUN Xiao , LIU Haihua

Department of Epidemiology and Health Statistics, College of Public Health of Qingdao University, Qingdao, 266021, P.R.China;

Corresponding author：

ZHOU Xiaobin, Email: xiaobin_zhou@126.com

Keywords：

Pancreatic cancer; Pancreatic tumor; miRNA; microRNA; Diagnosis; Meta-analysis

DOI：

10.7507/1672-2531.201610031

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the diagnostic value of miRNAs for pancreatic cancer. Methods PubMed, Scopus, Web of Science, CBM, CNKI, WanFang Data and VIP databases were retrieved from inception to December 31^st 2015, to collect diagnostic accuracy studies about miRNAs for pancreatic cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by using the QUADAS-2 tool. Then meta-analysis was performed using MetaDiSc 1.4 and Stata 12.0 softwares. Results A total of 40 articles involving 109 studies were included. The results of meta-analysis showed that the pooled Sen, Spe, +LR, –LR and DOR were 0.81 (95%CI 0.80 to 0.82), 0.77 (95%CI 0.75 to 0.78), 3.15 (95%CI 2.78 to 3.58), 0.27 (95%CI 0.24 to 0.31) and 13.58 (95%CI 10.89 to 16.94), respectively. The AUC of SROC was 0.86 (95%CI 0.84 to 0.88). Subgroups analysis showed that: as to diagnostic accuracy, Caucasian was superior to Asian (AUC=0.89vs. 0.84); multiple-miRNAs profiling-based assays was superior to single miRNA assays (AUC=0.91vs. 0.84). Conclusion Current evidence suggests that miRNA has potential diagnostic value for pancreatic cancer, particularly using multiple miRNAs. Due to limited quality of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： ZHANG Yingying, ZHOU Xiaobin, ZHU Xiaoyan, SUN Xiao, LIU Haihua. Diagnostic value of miRNAs for pancreatic cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(1): 78-86. doi: 10.7507/1672-2531.201610031 Copy

1.	Sultana A, Smith CT, Cunningham D, et al. Meta, analyses of chemotherapy for locally advanced and metastatic pancreatic cancer: results of secondary end points analyses. Br J Cancer, 2008, 99(1): 6-13.
2.	Siegel RL, Fedewa SA, Miller KD, et al. Cancer statistics for Hispanics/Latinos, 2015. CA Cancer J Clini, 2015, 65(6): 457-480.
3.	Abue M, Yokoyama M, Shibuya R, et al. Circulating miR-483-3p and miR-21 is highly expressed in plasma of pancreatic cancer. Int J Oncol, 2015, 46(2): 539-547.
4.	Satake F K, Kanazawa G, Kho I, et al. A clinical evaluation of carbohydrate antigen 19-9 and carcinoembryonic antigen in patients with pancreatic carcinoma. J Surg Oncol, 1985, 29(1): 15-21.
5.	Ambros V. The functions of animal microRNAs. Nature, 2004, 431(7006): 350-355.
6.	Haug U, Wente MN, Seiler CM, et al. Stool testing for the early detection of pancreatic cancer: rationale and current evidence. Expert Rev Mol Diagn, 2008, 8(6): 753-759.
7.	Calin GA, Dumitru CD, Shimizu M, et al. Frequent deletions and down-regulation of micro-RNA genes miR15 and miR16 at 13q14 in chronic lymphocytic leukemia. Pro Natl Acad Sci USA, 2002, 99(24): 15524-15529.
8.	Navon R, Wang H, Steinfeld I, et al. Novel rank-based statistical methods reveal microRNAs with differential expression in multiple cancer types. Plos One, 2009, 4(11): e8003.
9.	Weber JA, Baxter DH, Zhang S, et al. The microRNA spectrum in 12 body fluids. Clin Chem, 2010, 56(11): 1733-1741.
10.	Zhao H, Shen J, Medico L, et al. A Pilot Study of Circulating miRNAs as Potential Biomarkers of Early Stage Breast Cancer. Plos One, 2010, 5(10): e13735.
11.	邬兰, 张永, 曾宪涛. QUADAS-2 在诊断准确性研究的质量评价工具中的应用. 湖北医药学院学报, 2013, (3): 201-208.
12.	Lee EJ, Gusev Y, Jiang J, et al. Expression profiling identifies microRNA signature in pancreatic cancer. Int J Cancer. 2007, 120(5): 1046-1054.
13.	Dillhoff M, Liu J, Frankel W, et al. MicroRNA-21 is overexpressed in pancreatic cancer and a potential predictor of survival. J Gastrointest Surg, 2008, 12(12): 2171-2176.
14.	Habbe N, Koorstra JB, Mendell JT, et al. MicroRNA miR, 155 is a biomarker of early pancreatic neoplasia. Cancer Biol Ther, 2009, 8(4): 340-346.
15.	Wang J, Chen J, Chang P, et al. MicroRNAs in plasma of pancreatic ductal adenocarcinoma patients as novel blood, based biomarkers of disease. Cancer Prev Res (Phila), 2009, 2(9): 807-813.
16.	Hanoun N, Delpu Y, Suriawinata AA, et al. The silencing of microRNA 148a production by DNA hypermethylation is an early event in pancreatic carcinogenesis. Clin Chem, 2010, 56(7): 1107-1118.
17.	Morimura R, Komatsu S, Ichikawa D, et al. Novel diagnostic value of circulating miR-18a in plasma of patients with pancreatic cancer. Br J Cancer, 2011, 22, 105(11): 1733-1740.
18.	Ryu JK, Matthaei H, Dal Molin, et al. Elevated microRNA miR-21 Levels in Pancreatic Cyst Fluid Are Predictive of Mucinous Precursor Lesions of Ductal Adenocarcinoma. Pancreatology, 2011, 11(3): 343-350.
19.	Szafranska-Schwarzbach AE, Whitcomb DC, Lloyd MB, et al. A Multi-center Study of a MicroRNA-based Assay for the Diagnosis of Pancreatic Ductal Adenocarcinoma in Fine Needle Aspirates. Pancreas, 2011, 40(8): 1356-1356.
20.	刘建强, 高军, 李兆申, 等. 胰腺癌患者血浆 miR-155 检测及其诊断价值. 中华胰腺病杂志, 2011, 11(2): 79-81.
21.	刘建强, 高军, 任艳, 等. 血浆 miR-21 对胰腺癌的诊断价值. 世界华人消化杂志, 2011, (8): 860-863.
22.	任艳, 高军, 王小玮, 等. 粪便 microRNAs 检测用于胰腺癌筛查诊断的价值评价. 中华胰腺病杂志, 2011, 11(2): 104-106.
23.	Bauer AS, Keller A, Costello E, et al. Diagnosis of Pancreatic Ductal Adenocarcinoma and Chronic Pancreatitis by Measurement of microRNA Abundance in Blood and Tissue. Plos One, 2012, 7(4): e34151.
24.	Liu J, Gao J, Du Y, et al. Combination of plasma microRNAs with serum CA19-9 for early detection of pancreatic cancer. Int J Cancer, 2012, 131(3): 683-691.
25.	Liu R, Chen X, Du Y, et al. Serum microRNA expression profile as a biomarker in the diagnosis and prognosis of pancreatic cancer. Clin Chem, 2012, 58(3): 610-618.
26.	Munding JB, Adai AT, Maghnouj A, et al. Global microRNA expression profiling of microdissected tissues identifies miR-135b as a novel biomarker for pancreatic ductal adenocarcinoma. Int J Cancer, 2012, 131(2): E86-95.
27.	Panarelli NC, Chen YT, Zhou XK, et al. MicroRNA expression aids the preoperative diagnosis of pancreatic ductal adenocarcinoma. Pancreas, 2012, 41(5): 685-690.
28.	Ren Y, Gao J, Liu JQ, et al. Differential signature of fecal microRNAs in patients with pancreatic cancer. Mol Med Rep, 2012, 6(1): 201-209.
29.	Schultz NA, Werner J, Willenbrock H, et al. MicroRNA expression profiles associated with pancreatic adenocarcinoma and ampullary adenocarcinoma. Mod Pathol, 2012, 25(12): 1609-1622.
30.	潘峰, 闻洋, 马士杰, 等. 血浆 miRNA 表达谱与胰腺癌相关性的研究. 南京医科大学学报(自然科学版), 2012, (11): 1541-1544.
31.	Li A, Yu J, Kim H, et al. MicroRNA array analysis finds elevated serum miR-1290 accurately distinguishes patients with low-stage pancreatic cancer from healthy and disease controls. Clin Cancer Res, 2013, 19(13): 3600-3610.
32.	Wang WS, Liu LX, Li GP, et al. Combined serum CA19-9 and miR-27a, 3p in peripheral blood mononuclear cells to diagnose pancreatic cancer. Cancer Prev Res (Phila), 2013, 6(4): 331-338.
33.	Zhao C, Zhang J, Zhang S, et al. Diagnostic and biological significance of microRNA-192 in pancreatic ductal adenocarcinoma. Oncol Rep, 2013, 30(1): 276-284.
34.	丁国平. 胰腺癌 exosomal microRNA 及其对 DC 免疫功能的影响. 杭州: 浙江大学, 2013.
35.	Madhavan B, Yue S, Galli U, et al. Combined evaluation of a panel of protein and miRNA serum-exosome biomarkers for pancreatic cancer diagnosis increases sensitivity and specificity. Int J Cancer, 2015, 136(11): 2616-2627.
36.	Ganepola GA, Rutledge JR, Suman P, et al. Novel blood-based microRNA biomarker panel for early diagnosis of pancreatic cancer. World J Gastrointest Oncol, 2014, 15, 6(1): 22-33.
37.	Cote GA, Gore AJ, Mcelyea SD, et al. A pilot study to develop a diagnostic test for pancreatic ductal adenocarcinoma based on differential expression of select miRNA in plasma and bile. Am J Gastroenterol, 2014, 109(12): 1942-1952.
38.	Lin MS, Chen WC, Huang JX, et al. Aberrant expression of microRNAs in serum may identify individuals with pancreatic cancer. Int J Clin Exp Med, 2014, 7(12): 5226-5234.
39.	Schultz NA, Dehlendorff C, Jensen BV, et al. MicroRNA Biomarkers in Whole Blood for Detection of Pancreatic Cancer. JAMA, 2014, 311(4): 392-404.
40.	Yang JY, Sun YW, Liu DJ, et al. MicroRNAs in stool samples as potential screening biomarkers for pancreatic ductal adenocarcinoma cancer. Am J Cancer Res, 2014, 4(6): 663-673.
41.	Zhang J, Zhao CY, Zhang SH, et al. Upregulation of miR-194 contributes to tumor growth and progression in pancreatic ductal adenocarcinoma. Oncol Rep, 2014, 31(3): 1157-1164.
42.	潘文征. 与胰腺癌诊断相关血浆 miRNA 的研究. 济南: 山东大学, 2014.
43.	石围. miR-155、miR-196a 异常表达在胰腺癌诊断中的研究. 昆明: 昆明医科大学, 2014.
44.	杨建宇, 孙勇伟, 花荣. 粪便 miRNAs 在胰腺导管腺癌筛查诊断中的应用价值. 肝胆胰外科杂志, 2014, 26(5): 388-392.
45.	Komatsu S, Ichikawa D, Miyamae M, et al. Malignant potential in pancreatic neoplasm; new insights provided by circulating miR-223 in plasma. Expert Opin Biol Ther, 2015, 15(6): 773-785.
46.	Permuth-wey J, Chen DT, Fulp WJ, et al. Plasma MicroRNAs as Novel Biomarkers for Patients with Intraductal Papillary Mucinous Neoplasms of the Pancreas. Cancer Prev Res (Phila), 2015, 8(9): 826-834.
47.	胡应霞, 张海蓉, 石围, 等. 血浆 miR-210 联合血清肿瘤标志物对胰腺癌的诊断价值. 世界华人消化杂志, 2015, (1): 147-152.
48.	汪善兵, 刘佳培, 雷开键, 等. 胰腺癌患者血浆中 miRNAs 异常高表达与临床特征相关性的研究. 肿瘤, 2015, (8): 905-910.
49.	王晓刚, 童钟, 金钢. 血清 miR-155 对胰腺癌诊断和预后评估的价值. 中华肝胆外科杂志, 2015, 21(3): 189-193.
50.	吴阳, 王佐正, 黄李雅. 血清 miRNAs 作为胰腺癌诊断肿瘤标志物的初步研究. 宁夏医学杂志, 2015, 37(8): 675-677.
51.	Jemal A, Siegel R, Xu J, et al. Cancer statistics. Ca Cancer J Clin, 2010, 60(5): 277-300.
52.	陈万青, 张思维, 曾红梅, 等. 中国 2010 年恶性肿瘤发病与死亡. 中国肿瘤, 2014, 23(1): 1-10.
53.	Real FX. A “catastrophic hypothesis” for pancreas cancer progression. Gastroenterology, 2003, 124(7): 1958-1964.
54.	曾宪涛, 何明武. 诊断准确性试验 Meta 分析软件一本通. 军事医学科学出版社, 2014.
55.	Ding Z, Wu H, Zhang J, et al. MicroRNAs as novel biomarkers for pancreatic cancer diagnosis: a meta-analysis based on 18 articles. Tumour Biol, 2014, 35(9): 8837-8848.
56.	Chen X, Ba Y, Ma L, et al. Characterization of microRNAs in serum: a novel class of biomarkers for diagnosis of cancer and other diseases. Cell Res, 2008, 18(10): 997-1006.

1. Sultana A, Smith CT, Cunningham D, et al. Meta, analyses of chemotherapy for locally advanced and metastatic pancreatic cancer: results of secondary end points analyses. Br J Cancer, 2008, 99(1): 6-13.
2. Siegel RL, Fedewa SA, Miller KD, et al. Cancer statistics for Hispanics/Latinos, 2015. CA Cancer J Clini, 2015, 65(6): 457-480.
3. Abue M, Yokoyama M, Shibuya R, et al. Circulating miR-483-3p and miR-21 is highly expressed in plasma of pancreatic cancer. Int J Oncol, 2015, 46(2): 539-547.
4. Satake F K, Kanazawa G, Kho I, et al. A clinical evaluation of carbohydrate antigen 19-9 and carcinoembryonic antigen in patients with pancreatic carcinoma. J Surg Oncol, 1985, 29(1): 15-21.
5. Ambros V. The functions of animal microRNAs. Nature, 2004, 431(7006): 350-355.
6. Haug U, Wente MN, Seiler CM, et al. Stool testing for the early detection of pancreatic cancer: rationale and current evidence. Expert Rev Mol Diagn, 2008, 8(6): 753-759.
7. Calin GA, Dumitru CD, Shimizu M, et al. Frequent deletions and down-regulation of micro-RNA genes miR15 and miR16 at 13q14 in chronic lymphocytic leukemia. Pro Natl Acad Sci USA, 2002, 99(24): 15524-15529.
8. Navon R, Wang H, Steinfeld I, et al. Novel rank-based statistical methods reveal microRNAs with differential expression in multiple cancer types. Plos One, 2009, 4(11): e8003.
9. Weber JA, Baxter DH, Zhang S, et al. The microRNA spectrum in 12 body fluids. Clin Chem, 2010, 56(11): 1733-1741.
10. Zhao H, Shen J, Medico L, et al. A Pilot Study of Circulating miRNAs as Potential Biomarkers of Early Stage Breast Cancer. Plos One, 2010, 5(10): e13735.
11. 邬兰, 张永, 曾宪涛. QUADAS-2 在诊断准确性研究的质量评价工具中的应用. 湖北医药学院学报, 2013, (3): 201-208.
12. Lee EJ, Gusev Y, Jiang J, et al. Expression profiling identifies microRNA signature in pancreatic cancer. Int J Cancer. 2007, 120(5): 1046-1054.
13. Dillhoff M, Liu J, Frankel W, et al. MicroRNA-21 is overexpressed in pancreatic cancer and a potential predictor of survival. J Gastrointest Surg, 2008, 12(12): 2171-2176.
14. Habbe N, Koorstra JB, Mendell JT, et al. MicroRNA miR, 155 is a biomarker of early pancreatic neoplasia. Cancer Biol Ther, 2009, 8(4): 340-346.
15. Wang J, Chen J, Chang P, et al. MicroRNAs in plasma of pancreatic ductal adenocarcinoma patients as novel blood, based biomarkers of disease. Cancer Prev Res (Phila), 2009, 2(9): 807-813.
16. Hanoun N, Delpu Y, Suriawinata AA, et al. The silencing of microRNA 148a production by DNA hypermethylation is an early event in pancreatic carcinogenesis. Clin Chem, 2010, 56(7): 1107-1118.
17. Morimura R, Komatsu S, Ichikawa D, et al. Novel diagnostic value of circulating miR-18a in plasma of patients with pancreatic cancer. Br J Cancer, 2011, 22, 105(11): 1733-1740.
18. Ryu JK, Matthaei H, Dal Molin, et al. Elevated microRNA miR-21 Levels in Pancreatic Cyst Fluid Are Predictive of Mucinous Precursor Lesions of Ductal Adenocarcinoma. Pancreatology, 2011, 11(3): 343-350.
19. Szafranska-Schwarzbach AE, Whitcomb DC, Lloyd MB, et al. A Multi-center Study of a MicroRNA-based Assay for the Diagnosis of Pancreatic Ductal Adenocarcinoma in Fine Needle Aspirates. Pancreas, 2011, 40(8): 1356-1356.
20. 刘建强, 高军, 李兆申, 等. 胰腺癌患者血浆 miR-155 检测及其诊断价值. 中华胰腺病杂志, 2011, 11(2): 79-81.
21. 刘建强, 高军, 任艳, 等. 血浆 miR-21 对胰腺癌的诊断价值. 世界华人消化杂志, 2011, (8): 860-863.
22. 任艳, 高军, 王小玮, 等. 粪便 microRNAs 检测用于胰腺癌筛查诊断的价值评价. 中华胰腺病杂志, 2011, 11(2): 104-106.
23. Bauer AS, Keller A, Costello E, et al. Diagnosis of Pancreatic Ductal Adenocarcinoma and Chronic Pancreatitis by Measurement of microRNA Abundance in Blood and Tissue. Plos One, 2012, 7(4): e34151.
24. Liu J, Gao J, Du Y, et al. Combination of plasma microRNAs with serum CA19-9 for early detection of pancreatic cancer. Int J Cancer, 2012, 131(3): 683-691.
25. Liu R, Chen X, Du Y, et al. Serum microRNA expression profile as a biomarker in the diagnosis and prognosis of pancreatic cancer. Clin Chem, 2012, 58(3): 610-618.
26. Munding JB, Adai AT, Maghnouj A, et al. Global microRNA expression profiling of microdissected tissues identifies miR-135b as a novel biomarker for pancreatic ductal adenocarcinoma. Int J Cancer, 2012, 131(2): E86-95.
27. Panarelli NC, Chen YT, Zhou XK, et al. MicroRNA expression aids the preoperative diagnosis of pancreatic ductal adenocarcinoma. Pancreas, 2012, 41(5): 685-690.
28. Ren Y, Gao J, Liu JQ, et al. Differential signature of fecal microRNAs in patients with pancreatic cancer. Mol Med Rep, 2012, 6(1): 201-209.
29. Schultz NA, Werner J, Willenbrock H, et al. MicroRNA expression profiles associated with pancreatic adenocarcinoma and ampullary adenocarcinoma. Mod Pathol, 2012, 25(12): 1609-1622.
30. 潘峰, 闻洋, 马士杰, 等. 血浆 miRNA 表达谱与胰腺癌相关性的研究. 南京医科大学学报(自然科学版), 2012, (11): 1541-1544.
31. Li A, Yu J, Kim H, et al. MicroRNA array analysis finds elevated serum miR-1290 accurately distinguishes patients with low-stage pancreatic cancer from healthy and disease controls. Clin Cancer Res, 2013, 19(13): 3600-3610.
32. Wang WS, Liu LX, Li GP, et al. Combined serum CA19-9 and miR-27a, 3p in peripheral blood mononuclear cells to diagnose pancreatic cancer. Cancer Prev Res (Phila), 2013, 6(4): 331-338.
33. Zhao C, Zhang J, Zhang S, et al. Diagnostic and biological significance of microRNA-192 in pancreatic ductal adenocarcinoma. Oncol Rep, 2013, 30(1): 276-284.
34. 丁国平. 胰腺癌 exosomal microRNA 及其对 DC 免疫功能的影响. 杭州: 浙江大学, 2013.
35. Madhavan B, Yue S, Galli U, et al. Combined evaluation of a panel of protein and miRNA serum-exosome biomarkers for pancreatic cancer diagnosis increases sensitivity and specificity. Int J Cancer, 2015, 136(11): 2616-2627.
36. Ganepola GA, Rutledge JR, Suman P, et al. Novel blood-based microRNA biomarker panel for early diagnosis of pancreatic cancer. World J Gastrointest Oncol, 2014, 15, 6(1): 22-33.
37. Cote GA, Gore AJ, Mcelyea SD, et al. A pilot study to develop a diagnostic test for pancreatic ductal adenocarcinoma based on differential expression of select miRNA in plasma and bile. Am J Gastroenterol, 2014, 109(12): 1942-1952.
38. Lin MS, Chen WC, Huang JX, et al. Aberrant expression of microRNAs in serum may identify individuals with pancreatic cancer. Int J Clin Exp Med, 2014, 7(12): 5226-5234.
39. Schultz NA, Dehlendorff C, Jensen BV, et al. MicroRNA Biomarkers in Whole Blood for Detection of Pancreatic Cancer. JAMA, 2014, 311(4): 392-404.
40. Yang JY, Sun YW, Liu DJ, et al. MicroRNAs in stool samples as potential screening biomarkers for pancreatic ductal adenocarcinoma cancer. Am J Cancer Res, 2014, 4(6): 663-673.
41. Zhang J, Zhao CY, Zhang SH, et al. Upregulation of miR-194 contributes to tumor growth and progression in pancreatic ductal adenocarcinoma. Oncol Rep, 2014, 31(3): 1157-1164.
42. 潘文征. 与胰腺癌诊断相关血浆 miRNA 的研究. 济南: 山东大学, 2014.
43. 石围. miR-155、miR-196a 异常表达在胰腺癌诊断中的研究. 昆明: 昆明医科大学, 2014.
44. 杨建宇, 孙勇伟, 花荣. 粪便 miRNAs 在胰腺导管腺癌筛查诊断中的应用价值. 肝胆胰外科杂志, 2014, 26(5): 388-392.
45. Komatsu S, Ichikawa D, Miyamae M, et al. Malignant potential in pancreatic neoplasm; new insights provided by circulating miR-223 in plasma. Expert Opin Biol Ther, 2015, 15(6): 773-785.
46. Permuth-wey J, Chen DT, Fulp WJ, et al. Plasma MicroRNAs as Novel Biomarkers for Patients with Intraductal Papillary Mucinous Neoplasms of the Pancreas. Cancer Prev Res (Phila), 2015, 8(9): 826-834.
47. 胡应霞, 张海蓉, 石围, 等. 血浆 miR-210 联合血清肿瘤标志物对胰腺癌的诊断价值. 世界华人消化杂志, 2015, (1): 147-152.
48. 汪善兵, 刘佳培, 雷开键, 等. 胰腺癌患者血浆中 miRNAs 异常高表达与临床特征相关性的研究. 肿瘤, 2015, (8): 905-910.
49. 王晓刚, 童钟, 金钢. 血清 miR-155 对胰腺癌诊断和预后评估的价值. 中华肝胆外科杂志, 2015, 21(3): 189-193.
50. 吴阳, 王佐正, 黄李雅. 血清 miRNAs 作为胰腺癌诊断肿瘤标志物的初步研究. 宁夏医学杂志, 2015, 37(8): 675-677.
51. Jemal A, Siegel R, Xu J, et al. Cancer statistics. Ca Cancer J Clin, 2010, 60(5): 277-300.
52. 陈万青, 张思维, 曾红梅, 等. 中国 2010 年恶性肿瘤发病与死亡. 中国肿瘤, 2014, 23(1): 1-10.
53. Real FX. A “catastrophic hypothesis” for pancreas cancer progression. Gastroenterology, 2003, 124(7): 1958-1964.
54. 曾宪涛, 何明武. 诊断准确性试验 Meta 分析软件一本通. 军事医学科学出版社, 2014.
55. Ding Z, Wu H, Zhang J, et al. MicroRNAs as novel biomarkers for pancreatic cancer diagnosis: a meta-analysis based on 18 articles. Tumour Biol, 2014, 35(9): 8837-8848.
56. Chen X, Ba Y, Ma L, et al. Characterization of microRNAs in serum: a novel class of biomarkers for diagnosis of cancer and other diseases. Cell Res, 2008, 18(10): 997-1006.

Chinese Journal of Evidence-Based Medicine

Diagnostic value of miRNAs for pancreatic cancer: a meta-analysis

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