Busch Evan L, McGraw Kathleen A, Sandler Robert S
Authors' Affiliations: Departments of Epidemiology and.
Health Sciences Library, University of North Carolina, Chapel Hill, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2014 Jul;23(7):1164-75. doi: 10.1158/1055-9965.EPI-14-0017. Epub 2014 May 3.
Epithelial-mesenchymal transition (EMT) is thought to be an important mechanism of cancer cell metastasis. Clinical measurement of EMT markers in primary tumors could improve risk stratification and treatment decisions by identifying patients who potentially have metastatic disease. To evaluate the potential of EMT markers that could be used for risk stratification for patients with colorectal cancer, we conducted a systematic review of studies (N = 30) that measured at least one of a selection of EMT markers in primary tumors and patient outcomes. Fifteen of 30 studies (50%) reported at least one statistically significant result supporting a role for one of the selected EMT markers in identifying patients at risk for worse outcomes. Importantly, however, we identified design inconsistencies that limited inferences and prevented meta-analysis of data. We offer a number of recommendations to make future studies more informative and standardized, including consistent sampling of different parts of the primary tumor, larger sample sizes, and measurement of both protein and RNA expression of a given EMT marker in the same tumors. Strengthening the literature per our recommendations could facilitate translating EMT markers to clinical use.
上皮-间质转化（EMT）被认为是癌细胞转移的重要机制。通过识别可能患有转移性疾病的患者，在原发性肿瘤中对EMT标志物进行临床检测可以改善风险分层和治疗决策。为了评估可用于结直肠癌患者风险分层的EMT标志物的潜力，我们对30项研究进行了系统评价，这些研究测量了原发性肿瘤中一系列EMT标志物中的至少一种以及患者的预后情况。30项研究中有15项（50%）报告了至少一项具有统计学意义的结果，支持所选EMT标志物之一在识别预后较差风险患者中的作用。然而，重要的是，我们发现了设计上的不一致之处，这些不一致限制了推断并妨碍了对数据进行荟萃分析。我们提出了一些建议，以使未来的研究更具信息性和标准化，包括对原发性肿瘤不同部位进行一致的采样、更大的样本量，以及在同一肿瘤中测量给定EMT标志物的蛋白质和RNA表达。按照我们的建议加强文献研究可以促进将EMT标志物转化为临床应用。
