Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, 75 Micras Asias str., Goudi-Athens 115 27, Greece.
BMC Cancer. 2011 Aug 4;11:336. doi: 10.1186/1471-2407-11-336.
The diagnostic value and prognostic significance of circulating tumor cell (CTC) detection in patients with bladder cancer is controversial. We performed a meta-analysis to consolidate current evidence regarding the use of CTC detection assays to diagnose bladder and other urothelial cancers and the association of CTC positivity with advanced, remote disease.
Studies that investigated the presence of CTCs in the peripheral blood of patients with bladder cancer and/or urothelial cancer were identified and reviewed. Sensitivities, specificities, and positive (LR+) and negative likelihood ratios (LR-) of CTC detection in individual studies were calculated and meta-analyzed by random effects model. Overall odds ratio of CTC positivity in patients with advanced disease versus those with organ-confined cancer was also calculated.
Overall sensitivity of CTC detection assays was 35.1% (95%CI, 32.4-38%); specificity, LR+, and LR- was 89.4% (95%CI, 87.2-91.3%), 3.77 (95%CI, 1.95-7.30) and 0.72 (95%CI, 0.64-0.81). CTC-positive patients were significantly more likely to have advanced (stage III-IV) disease compared with CTC-negative patients (OR, 5.05; 95%CI, 2.49-10.26).
CTC evaluation can confirm tumor diagnosis and identify patients with advanced bladder cancer. However, due to the low overall sensitivity, CTC detection assays should not be used as initial screening tests.
循环肿瘤细胞（CTC）检测在膀胱癌患者中的诊断价值和预后意义存在争议。我们进行了一项荟萃分析，以整合目前关于使用 CTC 检测方法诊断膀胱癌和其他尿路上皮癌以及 CTC 阳性与晚期、远处疾病的相关性的证据。
确定并回顾了研究外周血中存在膀胱癌和/或尿路上皮癌患者 CTC 的研究。通过随机效应模型计算和荟萃分析了个体研究中 CTC 检测的敏感性、特异性、阳性（LR+）和阴性似然比（LR-）。还计算了晚期疾病患者与器官局限型癌症患者 CTC 阳性的总体优势比。
CTC 检测方法的总体敏感性为 35.1%（95%CI，32.4-38%）；特异性、LR+和 LR-分别为 89.4%（95%CI，87.2-91.3%）、3.77（95%CI，1.95-7.30）和 0.72（95%CI，0.64-0.81）。与 CTC 阴性患者相比，CTC 阳性患者更有可能患有晚期（III-IV 期）疾病（OR，5.05；95%CI，2.49-10.26）。
CTC 评估可确认肿瘤诊断并识别患有晚期膀胱癌的患者。然而，由于总体敏感性较低，CTC 检测方法不应作为初始筛选试验。
