The diagnostic accuracy of urine-derived exosomes for bladder cancer: a systematic review and meta-analysis

IntroductionUrine-derived exosomes could potentially be biomarkers for bladder cancer (BC) diagnosis. This study aimed to systematically evaluate the diagnostic worth of urine-derived exosomes in BC patients through a meta-analysis of diverse studies.MethodsA systematic search was carried out in PubMed, Web of Science, Embase, Cochrane, and CNKI databases to obtain the literature concerning the diagnosis of BC via urine-derived exosomes. A literature retrieval strategy was devised to pick articles and extract needed data from the literature. QUADS-2 was used to evaluate the quality of the included literatures, and the aggregated diagnostic effect was assessed by calculating the area under the aggregated SROC curve. All statistical analyses and plots were conducted with STATA 14.0 and RevMan5.3.ResultsA total of 678 articles were retrieved by means of the search strategy of the online database. Through screening, 21 articles were obtained, involving 3348 participants and 77 studies. The meta-analysis of the results indicated that urinary exosomes had a combined sensitivity of 0.75, a specificity of 0.77, and a combined AUC of 0.83 for the diagnosis of BC, suggesting that urine-derived exosomes have a relatively satisfactory diagnostic effect in the detection of BC. Among the subgroups classified by biomarker, long non-coding RNAs (lncRNAs) had the highest comprehensive sensitivity (SEN = 0.78), and miRNAs had the highest comprehensive specificity (SPN = 0.81). In other subgroup analyses, the biomarker panel for multiple exosomes combined diagnosis demonstrated the best diagnostic efficacy, with a combined the area under the curve ( AUC) of 0.87.ConclusionsAs a novel biomarker, urine-derived exosomes have significant diagnostic prospects in the diagnosis of BC. Nevertheless, their application in clinical settings still demands a considerable number of clinical trials to confirm their clinical feasibility and practicability.