1 Department of Respiratory Medicine, 2 Department of Orthopedics Medicine, Jinling Hospital, Southern Medical University, Nanjing 210002, China.
Transl Lung Cancer Res. 2015 Oct;4(5):610-8. doi: 10.3978/j.issn.2218-6751.2015.10.03.
Circulating endothelial cells (CECs) have been indicated as a potential biomarker of vascular damage in a variety of cancers. Several studies have revealed CECs may reflect the extent of tumor angiogenesis; however, the role of CECs in the prognosis of non-small cell lung cancer (NSCLC) is undetermined to date. A meta-analysis has been prepared to determine whether the base level of CECs and the changes of CECs after therapy (∆CECs: post-therapeutic value minus the pre- therapeutic value) could be considered as a prognostic tool for patients with NSCLC.
Systematic reviews of studies published before April 30 2015 were conducted on the association between the levels of CECs or ∆CECs and the prognosis of NSCLC in several data bases. Hazard ratios (HRs) and the 95% confidence intervals (CIs) were used to collate the data. Similarly, heterogeneity and publication bias were also evaluated.
A total of nine studies, containing eight prospective studies and one retrospective study, involving 515 patients was identified. Patients with higher level of CECs counts at baseline were associated with longer progression-free survival (PFS) (HR 0.71, 95% CI: 0.529-0.891). ∆CECs could also be considered a prognostic indicator in NSCLC patients (HR 0.575, 95% CI: 0.401-0.75). The former and the later are without a significant heterogeneity in the data (I(2)=21.2% and 0.0%, P=0.274 and 0.870, respectively). However, there was no correlation between the base level of CECs and the overall survival (OS) (HR 0.914, 95% CI: 0.560-1.267, I(2)=43.6%, P=0.150).
Higher levels of CECs counts at baseline and the ensuing decrease after therapy demonstrated a positive correlation with longer PFS in NSCLC patients. But this phenomenon has not been found in OS. From a certain perspective, CECs counts and ∆CECs could be potential prognostic indicators for NSCLC patients.
循环内皮细胞（CEC）已被证实为多种癌症中血管损伤的潜在生物标志物。多项研究表明，CEC 可能反映肿瘤血管生成的程度；然而，CEC 在非小细胞肺癌（NSCLC）预后中的作用尚未确定。目前已经进行了一项荟萃分析，以确定 CEC 的基础水平以及治疗后 CEC 的变化（∆CECs：治疗后值减去治疗前值）是否可被视为 NSCLC 患者的预后工具。
在 2015 年 4 月 30 日前，在多个数据库中对 CEC 水平或 ∆CECs 与 NSCLC 预后之间关系的研究进行了系统评价。使用危险比（HR）和 95％置信区间（CI）来整理数据。同样，还评估了异质性和发表偏倚。
共确定了 9 项研究，其中包括 8 项前瞻性研究和 1 项回顾性研究，共涉及 515 例患者。基线时 CEC 计数较高的患者无进展生存期（PFS）更长（HR 0.71，95％CI：0.529-0.891）。∆CECs 也可被视为 NSCLC 患者的预后指标（HR 0.575，95％CI：0.401-0.75）。在数据中，前者和后者没有显著的异质性（I(2)=21.2％和 0.0％，P=0.274 和 0.870）。但是，CEC 的基础水平与总生存期（OS）之间没有相关性（HR 0.914，95％CI：0.560-1.267，I(2)=43.6％，P=0.150）。
基线时 CEC 计数较高，治疗后下降与 NSCLC 患者的 PFS 延长呈正相关。但在 OS 中并未发现这种现象。从某种角度来看，CEC 计数和 ∆CECs 可能是非小细胞肺癌患者潜在的预后指标。
