Cancer Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
J Evid Based Med. 2024 Jun;17(2):329-340. doi: 10.1111/jebm.12606. Epub 2024 Apr 10.
The efficacy and prognostic value of circulating tumor cells (CTCs) in nonsmall cell lung cancer (NSCLC) are controversial based on the existing research. This systematic review and meta-analysis evaluated the significance of CTCs in NSCLC therapy monitoring and prognosis prediction, supporting their potential as clinical biomarkers.
We conducted a comprehensive search of PubMed, Embase, Web of Science, The Cochrane Library, WanFang Data, CNKI, and VIP through September 20, 2023. Inclusion criteria were cohort studies involving NSCLC patients, focusing on peripheral blood CTCs, and assessing outcomes such as pre- and posttreatment CTC rates or levels, progression-free survival (PFS), and overall survival (OS). Two reviewers independently extracted the data and assessed risk of bias using the Newcastle-Ottawa Scale. We utilized Review Manager 5.4.1 for meta-analysis, calculating pooled odds ratios (ORs) for dichotomous outcomes, mean differences for continuous variables and hazard ratios (HRs) for survival data, applying fixed- or random-effects models based on heterogeneity assessed by the I statistic. This study was registered in PROSPERO (No. CRD42023450035).
Twenty-two eligible studies with a total of 1674 NSCLC patients were included. Meta-analysis results showed that the CTCs-positive rate (OR = 0.59, 95% CI 0.45 to 0.77, p = 0.0001) and CTCs count (mean difference = -3.10, 95% CI -5.52 to -0.69, p = 0.01) were significantly decreased after antitumor treatment. Compared with the CTCs nonreduced group, the CTC-reduced group showed better PFS (HR = 1.71, 95% CI 1.35 to 2.17, p < 0.00001) and OS (HR = 1.50, 95% CI 1.21 to 1.86, p = 0.0003) after treatment. PFS and OS in CTC-positive groups were lower than those in the CTCs-negative group pretreatment (HR = 2.49, 95% CI 1.78 to 3.47, p < 0.00001; HR = 1.80, 95% CI 1.29 to 2.52, p = 0.0006) and posttreatment (HR = 3.36, 95% CI 2.12 to 5.33, p < 0.00001; HR = 3.31, 95% CI 1.75 to 6.27, p = 0.0002).
CTCs can be used as a biomarker to monitor NSCLC efficacy, predict prognosis and guide follow-up treatment.
基于现有研究，循环肿瘤细胞（CTC）在非小细胞肺癌（NSCLC）中的疗效和预后价值存在争议。本系统评价和荟萃分析评估了 CTC 在 NSCLC 治疗监测和预后预测中的意义，支持其作为临床生物标志物的潜力。
我们对 PubMed、Embase、Web of Science、The Cochrane Library、万方数据、中国知网和 VIP 进行了全面检索，检索时间截至 2023 年 9 月 20 日。纳入标准为纳入 NSCLC 患者的队列研究，重点关注外周血 CTC，并评估治疗前后 CTC 率或水平、无进展生存期（PFS）和总生存期（OS）等结局。两位评审员独立提取数据，并使用纽卡斯尔-渥太华量表评估偏倚风险。我们使用 Review Manager 5.4.1 进行荟萃分析，对于二分类结局，计算合并优势比（OR）；对于连续变量，计算合并均数差；对于生存数据，计算合并风险比（HR），并根据 I ² 统计量评估的异质性，应用固定效应或随机效应模型。本研究已在 PROSPERO（注册号：CRD42023450035）注册。
纳入了 22 项研究，共纳入了 1674 名 NSCLC 患者。荟萃分析结果表明，抗肿瘤治疗后 CTCs 阳性率（OR=0.59，95%CI 0.45 至 0.77，p=0.0001）和 CTCs 计数（均数差=-3.10，95%CI -5.52 至 -0.69，p=0.01）显著降低。与 CTC 未减少组相比，CTC 减少组的 PFS（HR=1.71，95%CI 1.35 至 2.17，p<0.00001）和 OS（HR=1.50，95%CI 1.21 至 1.86，p=0.0003）更好。治疗前 CTC 阳性组的 PFS 和 OS 低于 CTC 阴性组（HR=2.49，95%CI 1.78 至 3.47，p<0.00001；HR=1.80，95%CI 1.29 至 2.52，p=0.0006），治疗后 CTC 阳性组的 PFS 和 OS 也低于 CTC 阴性组（HR=3.36，95%CI 2.12 至 5.33，p<0.00001；HR=3.31，95%CI 1.75 至 6.27，p=0.0002）。
CTC 可作为监测 NSCLC 疗效、预测预后和指导随访治疗的生物标志物。
