Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Clin Cancer Res. 2012 Oct 15;18(20):5701-10. doi: 10.1158/1078-0432.CCR-12-1587. Epub 2012 Aug 20.
The prognostic value of circulating tumor cells (CTC) detected in breast cancer patients is currently under debate. Different time points of blood collections and various CTC assays have been used in the past decades. Here, we conducted the first comprehensive meta-analysis of published literature on the prognostic relevance of CTC, including patients with early and advanced disease.
A comprehensive search for articles published between January 1990 and January 2012 was conducted; reviews of each study were conducted and data were extracted. The main outcomes analyzed were overall survival (OS) and disease-free survival (DFS) in early-stage breast cancer patients, as well as progression-free survival (PFS) and OS in metastatic breast cancer patients. Pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated using the random and the fixed-effects models. Subgroup and sensitivity analyses were also conducted.
Forty-nine eligible studies enrolling 6,825 patients were identified. The presence of CTC was significantly associated with shorter survival in the total population. The prognostic value of CTC was significant in both early (DFS: HR, 2.86; 95% CI, 2.19-3.75; OS: HR, 2.78; 95% CI, 2.22-3.48) and metastatic breast cancer (PFS: HR, 1.78; 95% CI, 1.52-2.09; OS: HR, 2.33; 95% CI, 2.09-2.60). Further subgroup analyses showed that our results were stable irrespective of the CTC detection method and time point of blood withdrawal.
Our present meta-analysis indicates that the detection of CTC is a stable prognosticator in patients with early-stage and metastatic breast cancer. Further studies are required to explore the clinical utility of CTC in breast cancer.
目前，循环肿瘤细胞（CTC）在乳腺癌患者中的预后价值仍存在争议。在过去的几十年中，已经使用了不同的采血时间点和各种 CTC 检测方法。在此，我们对已发表的关于 CTC 预后相关性的文献进行了首次全面的荟萃分析，其中包括早期和晚期疾病患者。
对 1990 年 1 月至 2012 年 1 月期间发表的文章进行了全面检索；对每项研究进行了综述并提取数据。主要分析的结局包括早期乳腺癌患者的总生存（OS）和无病生存（DFS），以及转移性乳腺癌患者的无进展生存（PFS）和 OS。使用随机和固定效应模型计算合并风险比（HR）和 95%置信区间（CI）。还进行了亚组和敏感性分析。
共确定了 49 项符合条件的研究，共纳入 6825 例患者。CTC 的存在与总人群的生存时间缩短显著相关。在早期（DFS：HR，2.86；95%CI，2.19-3.75；OS：HR，2.78；95%CI，2.22-3.48）和转移性乳腺癌（PFS：HR，1.78；95%CI，1.52-2.09；OS：HR，2.33；95%CI，2.09-2.60）患者中，CTC 的预后价值均具有统计学意义。进一步的亚组分析表明，无论采用何种 CTC 检测方法和采血时间点，我们的结果都是稳定的。
本荟萃分析表明，在早期和转移性乳腺癌患者中，CTC 的检测是一种稳定的预后标志物。需要进一步的研究来探讨 CTC 在乳腺癌中的临床应用价值。
