The role of exosomal microRNAs in detecting hepatocellular carcinoma: A systematic review and meta-analysis

BACKGROUND: Exosomal microRNAs (miRNAs) have emerged as promising non-invasive biomarkers for hepatocellular carcinoma (HCC). Nevertheless, the overall diagnostic performance of exosomal miRNAs in HCC was still less reported. Therefore, this meta-analysis aimed to systematically assess the pooled diagnostic efficacy of exosomal miRNAs for HCC. METHODS: A literature search was performed in accordance with the PRISMA guidelines, utilizing the PubMed, Web of Science, EMBASE, and CNKI databases up to December 22, 2024. The quality of the included studies was evaluated using the QUADAS-2 tool. A random-effects model was applied to calculate the pooled sensitivity and specificity. The overall diagnostic performance was assessed by generating a summary receiver operating characteristic (sROC) curve and calculating the area under the curve (AUC). All statistical analyses were conducted using Meta-Disc (version 1.4) and STATA (version 16). RESULT: A total of 1442 HCC patients, 761 health controls (HC), and 1091 chronic liver disease (CLD) were identified in 18 individual publications. The sROC analysis showed that the pooled AUC, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) with 95% confidence interval (CI) were 0.89 (0.86, 0.91), 0.84(0.80, 0.88), 0.79(0.71, 0.86), 4.1(2.8, 5.9), 0.20(0.15, 0.27), 21(11, 37), respectively. CONCLUSION: This meta-analysis confirms that exosomal miRNAs represent promising novel, non-invasive biomarkers for HCC screening. Furthermore, exosomal miRNAs demonstrate superior diagnostic accuracy in HCC patients with HBV or HCV infection compared to those with other etiologies.