Cell-free DNA in blood and urine as a diagnostic tool for bladder cancer: a meta-analysis.
OBJECTIVE
To assess the diagnostic performance of cell-free DNA assays in the detection of bladder cancer.


PATIENTS AND METHODS
The quality of the studies included in this meta-analysis was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Statistical analyses were performed using the software RevMan 5.3 and Stata 14.0. We assessed the pooled sensitivity and specificity, positive/negative likelihood ratios (PLRs/NLRs), diagnostic odds ratios (DORs), and corresponding 95% confidence intervals (95% CIs). Summary receiver operating characteristic curve (ROC curve) and area under the curve (AUC) were used to summarize the overall test performance. Heterogeneity and publication bias were also examined.


RESULTS
Eleven studies included 802 bladder cancer patients and 668 controls met the eligibility criteria. The overall diagnostic accuracy was measured as follows: sensitivity 0.71 (95% CI = 0.64-0.77), specificity 0.78 (95% CI = 0.70-0.85), PLR 3.3 (95% CI = 2.4-54.5), NLR 0.37 (95% CI = 0.30-0.46), DOR 9 (95% CI = 6-14), and AUC 0.80 (95% CI = 0.77-0.83). Subgroup analysis suggested that ethnicity significantly accounted for the heterogeneity of specificity. The Deeks' funnel plot asymmetry test (P = 0.97) suggested no potential publication bias.


CONCLUSIONS
Cell-free DNA has a high diagnostic value in bladder cancer.
['Wang|Xin-Shuai|XS|', 'Zhao|Meng-Qi|MQ|', 'Zhang|Li|L|', 'Kong|De-Jiu|DJ|', 'Ding|Xue-Zhen|XZ|', 'Hu|Xiao-Chen|XC|', 'Yang|Jun-Qiang|JQ|', 'Gao|She-Gan|SG|']
Cell-free DNA bladder cancer biomarker diagnosis