Diagnostic performance of circulating exosomes in human cancer: A meta‐analysis

Abstract

Background Cancer has become a public health problem with high morbidity and mortality. Recent publications have shown that exosomes can be used as potential diagnostic biomarkers of cancer. However, the diagnostic accuracy and reliability of circulating exosomes remain unclear. The present meta‐analysis was conducted to comprehensively summarize the overall diagnostic performance of circulating exosomes for cancer. Methods Eligible studies published up to June 27, 2019, on PubMed, Embase, and Cochrane Library were selected for the meta‐analysis. All statistical analyses were performed by STATA 15.1 statistical software and Meta‐DiSc 1.4. Quality Assessment for Studies of Diagnostic Accuracy 2 tool was used to access the quality of included studies. A bivariate mixed‐effects model was applied to calculate the diagnostic indexes from included studies. Results A total of 5924 participants comprising 3161 cases and 2763 controls from 42 eligible studies were analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under the curve with 95% confidence intervals (95% CI) were as follows: 0.79 (0.75‐0.82), 0.81 (0.78‐0.84), 4.1 (3.5‐4.8), 0.26 (0.22‐0.31), 16 (12‐21), and 0.87 (0.84‐0.89), respectively. Sensitivity analysis suggested no study exclusively contributed to the heterogeneity, and Deeks' funnel plot asymmetry test indicated no potential publication bias ( P = .09). Conclusions The meta‐analysis indicated that circulating exosomes could serve as effective and minimally invasive biomarkers for diagnosis of cancer, especially in patients with hepatocellular carcinoma or ovarian cancer, serum‐based samples and exosomal proteins.

Selective Internal Radiotherapy Changes the Immune Profiles of Extracellular Vesicles and Their Immune Origin in Patients with Inoperable Cholangiocarcinoma

“…Their work showed that transforming growth factor beta (TGFβ)1 expressed at the exosome surface induced differentiation from fibroblasts to tumor-promoting myofibroblasts which act pro-angiogenetic [ 20 , 21 ]. Furthermore, it was shown that the levels of circulating exosomes had a promising diagnostic potential in the context of pancreatic, hepatocellular, and ovarian carcinoma [ 22 , 23 ]. Also, the count of circulating exosomes has been demonstrated as a prognostic marker for lung cancer patients in a meta-analysis [ 24 ].…”

The diagnostic value of exosomal circular RNAs in cancer patients: A systematic review and meta‐analysis

“…One meta‐analysis that evaluated the overall diagnostic value of circulating exosomes in cancers demonstrated that tumor types and exosomes sources could lead to heterogeneity. 39 In detail, the sensitivity, specificity, and AUC in hepatocellular carcinoma and ovarian cancer are higher than those in other cancers. Compared with plasma‐derived exosomes, serum‐derived exosomes had a better diagnostic performance.…”

“…No significant difference between subgroups might be generated by too few studies included in this study. One meta‐analysis that evaluated the overall diagnostic value of circulating exosomes in cancers demonstrated that tumor types and exosomes sources could lead to heterogeneity 39 . In detail, the sensitivity, specificity, and AUC in hepatocellular carcinoma and ovarian cancer are higher than those in other cancers.…”

Small Extracellular Vesicles and Their Involvement in Cancer Resistance: An Up-to-Date Review

“…Many studies have indicated that EVs with high sensitivity and specificity can be used as liquid biopsies in the diagnosis and prognosis of patients’ outcomes and responses to treatment [ 12 , 13 , 14 , 15 ]. Additionally, meta-analyses, a powerful statistical tool, have confirmed the clinical utility of EVs for cancer detection and prognoses [ 16 , 17 , 18 , 19 ]. Let us say, then, that EVs are cancer detection’s ‘ne plus ultra’.…”