Yang Chaogang, Zou Kun, Yuan Zewei, Guo Tangxi, Xiong Bin
Department of Gastrointestinal Surgery & Department of Gastric and Colorectal Surgical Oncology, Zhongnan Hospital of Wuhan University.
Hubei Key Laboratory of Tumor Biological Behaviors.
Onco Targets Ther. 2018 Feb 26;11:1013-1023. doi: 10.2147/OTT.S154114. eCollection 2018.
Circulating tumor cells (CTCs) have been proposed as a marker for predicting the prognosis of cancer. However, the prognostic value of CTCs detected with the CellSearch System in patients with gastric cancer (GC) remains controversial. We performed a meta-analysis of available studies to investigate this topic.
Two authors systematically searched the studies independently in PubMed, Science Citation Index, Cochrane Database, Embase, and the references in relevant studies (up to September 2017) using keywords. Our meta-analysis was performed in Stata software, version 12.0 (2011; Stata Corp, College Station, TX, USA), with the risk ratio (RR), hazard ratio (HR), and 95% CI as the effect measures. Subgroup analyses and meta-regression were also conducted.
Seven studies (including eight sets of data) containing 579 patients with GC from four countries were included in this meta-analysis. The pooled results showed CTC-positive status detected by the CellSearch System was significantly associated with poor overall survival (HR =2.09, 95% CI [1.71, 2.55], <0.001, =31.5%) and progression-free survival (HR =2.11, 95% CI [1.25, 3.57], =0.005, =75.6%) of patients with GC, regardless of sampling time. The disease control rate of CTC-positive group was lower than that of CTC-negative group for both baseline and intra-therapy, although no statistical difference existed at both sampling time points (baseline: 69.5% versus 81.8%, RR=0.79, 95% CI [0.54, 1.16], =0.23, =68.0%; intra-therapy: 50.0% versus 85.9%, RR=0.24, 95% CI [0.02, 3.13], =0.28, =87.4%).
Our meta-analysis demonstrated that CTCs detected with the CellSearch System from the peripheral blood had significant prognostic value and might predict poor response to chemotherapy for patients with GC.
循环肿瘤细胞（CTCs）已被提议作为预测癌症预后的标志物。然而，使用CellSearch系统检测到的CTCs在胃癌（GC）患者中的预后价值仍存在争议。我们对现有研究进行了荟萃分析以探讨该主题。
两位作者使用关键词在PubMed、科学引文索引、Cochrane数据库、Embase以及相关研究的参考文献（截至2017年9月）中独立系统地检索研究。我们的荟萃分析在Stata软件12.0版（2011年；美国德克萨斯州大学站Stata公司）中进行，以风险比（RR）、风险比（HR）和95%置信区间作为效应量。还进行了亚组分析和荟萃回归。
本荟萃分析纳入了来自四个国家的七项研究（包括八组数据），共579例GC患者。汇总结果显示，无论采样时间如何，使用CellSearch系统检测到的CTCs阳性状态与GC患者的总生存期差（HR = 2.09，95%置信区间[1.71, 2.55]，<0.001，I² = 31.5%）和无进展生存期差（HR = 2.11，95%置信区间[1.25, 3.57]，= 0.005，I² = 75.6%）显著相关。在基线和治疗期间，CTCs阳性组的疾病控制率均低于CTCs阴性组，尽管在两个采样时间点均无统计学差异（基线：69.5%对81.8%，RR = 0.79，95%置信区间[0.54, 1.16] = 0.23，I² = 68.0%；治疗期间：50.0%对85.9%，RR = 0.24，95%置信区间[0.02, 3.13] = 0.28，I² = 87.4%）。
我们的荟萃分析表明，使用CellSearch系统从外周血中检测到的CTCs具有显著的预后价值，并且可能预测GC患者对化疗的反应较差。
