Diagnostic performance of SHOX2 promoter methylation as biomarker for lung cancer identification: A meta-analysis update

Objective To evaluate the diagnostic performance of short state homeobox 2 (SHOX2) promoter methylation as biomarker for lung cancer identification through aggregating the open published data. Methods We did an electronic search in Pubmed, EMBASE, Ovid, Web of Science, Google Scholar, and the China National Knowledge Infrastructure (CNKI) to identify the publications related to SHOX2 promoter methylation and lung cancer. The diagnostic performance of sensitivity (SEN), specificity (SPE), odds ratio (DOR), and summary receiver operating characteristic (SROC) cure were aggregated by fixed or random effect model. Fagan's nomogram was used to investigate the post-test diagnostic probability. Deek's funnel plot and line regression test was applied to evaluate the publication bias. Results In total, 18 clinical studies about SHOX2 promoter methylation and lung cancer were included in the meta-analysis. The combined diagnostic SEN, SPE, DOR were 0.63 (95% CI = 0.54-0.70), 0.91 (95% CI = 0.87-0.94), and 16.84 (95% CI = 11.18-25.36) in random effect model respectively. The pooled area under the curve (AUC) of SROC was 0.88 (95% CI = 0.84-0.90). The post-test probability of lung cancer was 88% and 29% when SHOX2 methylated and unmethylated in humoral components given a pre-test probability of 50%. Deek's funnel plot and regression test indicated no publication bias (p = 0.62). Conclusion SHOX2 promoter methylation in humoral components may be a potential biomarker for lung cancer diagnosis with relative high diagnostic specificity.