Abstract: Objective: To systematically evaluate the value of exosome biomarkers in the diagnosis and prognosis of ovarian cancer (OC). Methods: The databases of CNKI, VIP, WanFang, PubMed, EMBASE, Web of Knowledge and Cochrane Library were searched to collect relevant researches on the diagnosis and prognosis of OC with exosome biomarkers by computers. Dated from the establishments of the databases to 20th December, 2019. Two reviewers screened research papers according to the inclusion and exclusion criteria, extracted data and assessed the risk bias of included studies. For diagnostic evaluation, the differences in the expression of exosome biomarkers between OC patients and non-OC controls were analyzed. For prognosis prediction, the correlation between the expression levels of exosome biomarkers and overall survival (OS) and disease free survival (DFS) of OC was analyzed. Results: A total of 10 studies were included. The exosomes extraction kit method was the most common method for purifying exosomes. Transmission electron microscope observation of morphology and detection of exosomal marker proteins were the basic methods for identifying exosomes. For diagnostic evaluation, serum-derived exosomes containing miR-200a, miR-145 showed high diagnostic value (the AUC of miR-200a was 0.91, sensitivity and specificity of which reached 83.9% and 90.0%, respectively; the AUC of miR-145 was 0.91, sensitivity and specificity of which reached 91.7% and 75.0%, respectively). Plasma-derived exosomes containing proteins fibrinogen alpha chain (FGA), gelsolin (GSN), and fibrinogen gamma chain (FGG) also had certain diagnostic values (the AUC of FGA, GSN, and FGG can reach 0.85, 0.83 and 0.74, respectively). For prognosis prediction, the high expression of miR-373, miR-200b and miR-200c from serum-derived exosomes was closely related to poorer OS in OC patients (HR was 2.1, 2.7, and 2.4; 95%CI were 1.0-4.3, 1.3-5.7 and 1.2-4.9); Similarly, the high expression of miR-200c in OC patients was also closely related to poorer PFS (HR=2.0, 95%CI: 1.1-3.6). Serum-derived exosomes containing long non-coding RNA aHIF was closely related to poorer OS in patients with OC (HR=3.70, 95%CI: 1.83-7.50). Conclusions: Exosome biomarkers could be used for early diagnosis and prognostic evaluation of patient with OC.

Key words: Ovarian neoplasms；, Exosomes；, Biomarkers；, Diagnosis；, Prognosis