Tan Yi, Wu Hao
Department of oncology, Wuhan Asia Heart Hospital, Wuhan, Hubei Province, China.
Department of Traditional Chinese Medicine, Renmin Hospital of Wuhan University, Hubei Province, China.
Curr Probl Cancer. 2018 Jan-Feb;42(1):95-106. doi: 10.1016/j.currproblcancer.2017.11.002. Epub 2017 Nov 29.
Circulating tumor cell (CTC) is a promising candidate biomarker for detection, monitoring, and survival prediction of colorectal cancer (CRC). However, the prognostic significance of CTCs in CRC is currently under debate. Here, we performed a meta-analysis to assess the prognostic value of CTC for patients diagnosed with CRC.
A comprehensive literature research had been performed in the Pubmed, Embase Databases, Cochrane Library, Elsevier Science Direct, and China National Knowledge Internet for studies reporting prognostic data of CTCs in CRC patients since December 2016. The main outcome measures were overall survival and progression-free survival. The hazard ratio (HR) and 95% CI were considered to be the effect measures. Subgroup and sensitivity analyses were also performed. We pooled in meta-analysis under a fixed-effect or random-effect model according to heterogeneity.
A total of 15 published studies containing 3129 patients matched the selection criteria were included in this meta-analysis. Overall analyses revealed that the presence of CTCs was significantly associated with poor mortality (overall survival: HR = 2.36, 95% CI: 1.87-2.97; P = 0.006) along with aggressive disease progression (progression-free survival: HR = 1.83, 95% CI: 1.42-2.36; P < 0.00001). Further subgroup analyses demonstrated that CTC-positive patients also had poor overall survival and disease progression in different subsets, including differences in time points of blood collection, detection methods, median follow-up month, and cutoff value of CTC.
Meta-analysis provides a strong evidence that the presence of CTCs was an independent prognosticator of poor survival outcomes for patients with CRC.
循环肿瘤细胞（CTC）是用于检测、监测和预测结直肠癌（CRC）患者生存情况的一种很有前景的候选生物标志物。然而，目前关于CRC中CTC的预后意义仍存在争议。在此，我们进行了一项荟萃分析，以评估CTC对CRC患者的预后价值。
自2016年12月以来，在PubMed、Embase数据库、Cochrane图书馆、爱思唯尔科学Direct和中国知网进行了全面的文献研究，以查找报告CRC患者CTC预后数据的研究。主要结局指标为总生存期和无进展生存期。风险比（HR）和95%置信区间（CI）被视为效应量。还进行了亚组分析和敏感性分析。根据异质性，我们在固定效应或随机效应模型下进行荟萃分析。
本荟萃分析共纳入15项已发表的研究，包含3129例符合选择标准的患者。总体分析显示，CTC的存在与较差的死亡率显著相关（总生存期：HR = 2.36，95%CI：1.87 - 2.97；P = 0.006），同时也与侵袭性疾病进展相关（无进展生存期：HR = 1.83，95%CI：1.42 - 2.36；P < 0.00001）。进一步的亚组分析表明，在不同亚组中，包括采血时间点、检测方法、中位随访月数和CTC临界值等方面，CTC阳性患者的总生存期和疾病进展也较差。
荟萃分析提供了强有力的证据，表明CTC的存在是CRC患者生存结局较差的独立预后指标。
