接受化疗的结直肠癌患者循环肿瘤细胞与肿瘤反应之间的关系：一项荟萃分析。

Relationship between circulating tumor cells and tumor response in colorectal cancer patients treated with chemotherapy: a meta-analysis.

作者信息

Huang Xuanzhang, Gao Peng, Song Yongxi, Sun Jingxu, Chen Xiaowan, Zhao Junhua, Liu Jing, Xu Huimian, Wang Zhenning

机构信息

Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City 110001, PR China.

出版信息

BMC Cancer. 2014 Dec 18;14:976. doi: 10.1186/1471-2407-14-976.

BACKGROUND

The prognostic value of circulating tumor cells (CTCs) in colorectal cancer (CRC) patients and their value in predicting tumor response to chemotherapy are controversial. The aim of this meta-analysis was to assess the prognostic and predictive value of CTCs in CRC patients treated with chemotherapy.

METHODS

A comprehensive literature search for relevant studies was conducted in PubMed, Embase, the Cochrane Database, the Science Citation Index and the Ovid Database, and the reference lists of relevant studies were also perused for other relevant studies (up to April, 2014). Using the random-effects model in Stata software, version 12.0, the meta-analysis was performed using odds ratios (ORs), risk ratios (RRs), hazard ratios (HRs) and 95% confidence intervals (CIs) as effect measures. Subgroup and sensitivity analyses were also performed.

RESULTS

Thirteen eligible studies were included. Our meta-analysis indicated that the disease control rate was significantly higher in CRC patients with CTC-low compared with CTC-high (RR = 1.354, 95% CI [1.002-1.830], p = 0.048). CRC patients in the CTC-high group were significantly associated with poor progression-free survival (PFS; HR = 2.500, 95% CI [1.746-3.580], p < 0.001) and poor overall survival (OS; HR = 2.856, 95% CI [1.959-4.164], p < 0.001). Patients who converted from CTC-low to CTC-high or who were persistently CTC-high had a worse disease progression (OR = 27.088, 95% CI [4.960-147.919], p < 0.001), PFS (HR = 2.095, 95% CI [1.105-3.969], p = 0.023) and OS (HR = 3.604, 95% CI [2.096-6.197], p < 0.001) than patients who converted from CTC-high to CTC-low.

CONCLUSIONS

Our meta-analysis indicates that CTCs are associated with prognosis in CRC patients treated with chemotherapy. Moreover, CTCs could provide additional prognostic information to tumor radiographic imaging and might be used as a surrogate and novel predictive marker for the response to chemotherapy.

背景

循环肿瘤细胞（CTC）在结直肠癌（CRC）患者中的预后价值及其在预测肿瘤对化疗反应方面的价值存在争议。本荟萃分析的目的是评估 CTC 在接受化疗的 CRC 患者中的预后和预测价值。

方法

在 PubMed、Embase、Cochrane 数据库、科学引文索引和 Ovid 数据库中对相关研究进行了全面的文献检索，并查阅了相关研究的参考文献列表以寻找其他相关研究（截至 2014 年 4 月）。使用 Stata 软件 12.0 版中的随机效应模型，以优势比（OR）、风险比（RR）、风险比（HR）和 95%置信区间（CI）作为效应量进行荟萃分析。还进行了亚组分析和敏感性分析。

结果

纳入了 13 项符合条件的研究。我们的荟萃分析表明，CTC 低的 CRC 患者的疾病控制率显著高于 CTC 高的患者（RR = 1.354，95%CI [1.002 - 1.830]，p = 0.048）。CTC 高组的 CRC 患者与无进展生存期（PFS）差显著相关（HR = 2.500，95%CI [1.746 - 3.580]，p < 0.001）和总生存期（OS）差显著相关（HR = 2.856，95%CI [1.959 - 4.164]，p < 0.001）。从 CTC 低转变为 CTC 高或持续为 CTC 高的患者，其疾病进展（OR = 27.088，95%CI [4.960 - 147.919]，p < 0.001）、PFS（HR = 2.095，95%CI [1.105 - 3.969]，p = 0.023）和 OS（HR = 3.604，95%CI [2.096 - 6.197]）比从 CTC 高转变为 CTC 低的患者更差。