肝细胞癌（HCC）的早期和非侵入性检测通常是无症状的，可以提高总体生存率。本系统评价和荟萃分析的目的是评估血清源性外泌体用于诊断HCC的诊断准确性。在PubMed、Web of Science和Scopus数据库中搜索相关研究，时间截至2023年4月。使用QUADAS-2检查表评估包括的研究的质量，并提取数据。对来自3993篇文献中的18个研究进行统计分析，并进行诊断荟萃分析。根据类型将生物标志物分为四组（外泌体miRNA、外泌体RNA、甲胎蛋白（AFP）和外泌体RNA+AFP组合），并分别进行荟萃分析。 外泌体miRNA的最高合并敏感度为0.86，外泌体RNA+AFP的最高合并特异性为0.89。此外，外泌体RNA+AFP的最高合并阳性似然比为7.55，最高合并诊断比值为35.96，最高合并曲线下面积为0.93。外泌体miRNA的最低合并阴性似然比为0.17。 外泌体生物标志物的诊断准确性优于AFP，将两者结合在一个组合中可以获得更好的结果。

Early and noninvasive detection of hepatocellular carcinoma (HCC), which is usually asymptomatic, can improve overall survival outcomes. The objective of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of serum-derived exosomes for diagnosing HCC.PubMed, Web of Science, and Scopus databases were searched for relevant studies up to April 2023. The quality of included studies was assessed using the QUADAS-2 checklist, and data were extracted. Statistical analysis was performed on 18 studies from 3,993 records, and a diagnostic meta-analysis was conducted. Biomarkers were categorized into four groups based on their type (exosomal miRNAs, exosomal RNAs, alpha-fetoprotein (AFP), and exosomal RNAs+AFP panel), and a meta-analysis was conducted for each category separately.The highest pooled sensitivity was 0.86 for exosomal miRNAs, and exosoml RNAs+AFP had the highest pooled specificity ;(0.89). Furthermore, exosoml RNAs+AFP had the highest pooled positive likelihood ratio ;(7.55), the highest pooled diagnostic odds ratio (35.96) and the highest pooled area under the curve (0.93). Exosomal miRNAs had the lowest pooled negative likelihood ratio ;(0.17).The diagnostic accuracy of exosomal biomarkers is superior to that of AFP, and combining the two in a panel yields the better results.