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The Diagnostic Value of Pyruvate Kinase Isoenzyme Type M2 for Biliary Tract Carcinoma. A Systematic Review and Meta-Analysis

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Wen Qin Wang,Wei Liu, Ning Zhang, Peng Hui Wang, Jian Zhong Cao, Jie Min Chen, Bing Lu Li, Xiao Dong He

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.271.wqw

Background & Aims:
Growing evidence has shown that M2-PK is involved in cancer diagnosis and prognosis. The overall diagnostic accuracy of the pyruvate kinase isoenzyme type M2 (M2-PK) in biliary tract carcinoma (BTC) remains controversial. We performed a meta-analysis to evaluate the diagnostic value of M2-PK for BTC.
Methods: The online PubMed, Cochrane, Web of Science, and Embase databases were searched for eligible studies published until August 8th, 2017. The Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2) was used to evaluate study quality. All statistical analyses were conducted with Stata 12.0.
Results: We included 7 studies from 5 articles with 410 patients with BTC and 438 controls. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and AUC for M2-PK in the diagnosis of BTC were 0.79 (95%CI 0.70-0.86), 0.81 (95%CI 0.71-0.88), 4.1 (95%CI 2.5-6.8), 0.26 (95%CI 0.16-0.41), 17.159 (95%CI 5.468-54.071), and 0.87 (95%CI 0.83-0.89), respectively. The same indicators assessed for CA19-9 were as follows: 0.70 (95%CI 0.62-0.77), 0.71 (95%CI 0.45-0.87), 2.38 (95%CI 1.2-4.73), 0.43 (95%CI 0.34-0.53), 6.28 (95%CI 2.4-16.44) and 0.73 (95%CI 0.69-0.77), respectively. Additionally, the diagnostic value of M2-PK varied based on characteristics of golden methods and different cut-off values.
Conclusions: This meta-analysis showed that M2-PK had a better diagnostic accuracy for BTC compared with CA19-9, with moderate diagnostic performance. However, prospective studies are required to confirm its diagnostic value.
Key words: Biliary tract cancer − Kinase Isoenzyme Type M2 − diagnosis − accuracy − meta-analysis.
Abbreviations: AC: ampullary carcinoma; BTC: biliary tract cancer; CC: cholangiocarcinoma; CA19-9: carbohydrate antigen 19-9; DOR: diagnostic odds ratio; GBC: gallbladder cancer; M2-PK: pyruvate kinase isoenzyme type 2; NLR: negative likelihood ratio; PLR: positive likelihood ratio; PK: pyruvate kinase; QUADAS-2: The Quality Assessment for Studies of Diagnostic Accuracy 2