DNA methylation urine test in the diagnosis of upper tract urothelial carcinoma: a systematic review and meta-analysis

Objective:The DNA methylation urine test, a noninvasive early detection method for upper tract urothelial carcinoma (UTUC), is currently in full swing. This study aimed to systematically assess its diagnostic performance on UTUC.Materials and methods:PubMed, Scopus, Embase, and Cochrane were our main databases when searching articles published from January 2000 to December 2023. Sensitivity and specificity were study primary endpoints. I 2 was used to evaluated heterogeneity, meanwhile subgroup and meta-regression analyses were adopted to investigated the source of heterogeneity. Sensitivity analysis was performed to evaluate the result robustness, while Deeks' funnel plot asymmetry test was for the publication bias.Results:Nine studies with 1326 patients were included. The pooled sensitivity was 0.89 (95% CI: 0.83-0.93) and specificity were 0.91 (95% CI: 0.83-0.96). The area under the receiver operating characteristic curve was 0.96 (95% CI: 0.93-0.97). Substantial heterogeneity was found during the data synthesis, whereas the pooled results remained robust in the sensitivity analysis. None of the potential covariates-urine sample collection method, population, country, methylation test method, or tumor grade-could account for the heterogeneity.Conclusion:DNA methylation urine test is a promising method with high efficiency for UTUC early detection. Nevertheless, owing to the significant heterogeneity, more well-organized studies are warranted to further explore its diagnostic efficiency and application context.