Yang Kang, Ouyang Peiwen, Gao Ke, Duan Zhaohui
Guangdong Medical University, Zhanjiang, China.
Clinical Laboratory and Pathology Department, Foshan Fosun Chancheng Hospital, Foshan, China.
Transl Cancer Res. 2025 Aug 31;14(8):4791-4803. doi: 10.21037/tcr-2025-565. Epub 2025 Aug 28.
In order to find new biomarkers related to gastric cancer diagnosis, in recent years, some researchers have confirmed that circulating tumor cells (CTCs) can be used in the diagnosis of gastric cancer, but the results are inconsistent among studies. In this study, we used meta-analysis to systematically evaluate the diagnostic value of CTCs for gastric cancer.
A comprehensive search was carried out using the following databases: PubMed, Embase, Cochrane Library, Web of Science, Ovid MEDLINE, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu Chinese database, Chinese Biomedical Literature (CBM) database, and Duxiu database. The aim of this extensive search was to find published studies that investigated the role of CTCs in the diagnosis of gastric cancer, especially in patients with both gastric and non-gastric cancer. The search spanned from the inception of each database to January 30, 2025. Subsequently, eligible studies underwent a stringent screening process. They were evaluated according to a set of pre-determined literature inclusion and exclusion criteria. The quality of the included literature was appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) scale, a tool developed to assess the quality of studies in the area of cancer research. Relevant data were then extracted, and a meta-analysis of the included studies was conducted using MetaDiSc 1.4 and Stata 16.0 software.
A total of 18 papers were included in this study, encompassing 1,399 gastric cancer patients and 750 non-gastric cancer controls. Meta-analysis indicated that the heterogeneity of the included papers was due to a non-threshold effect. Meta-regression analysis revealed that the identification of the test method might be the main source of heterogeneity. The random-effects model analysis showed that the combined sensitivity of the cell-based CTC test for diagnosing gastric cancer was 0.78 [95% confidence interval (CI): 0.76-0.80], the combined specificity was 0.93 (95% CI: 0.91-0.94), the combined positive likelihood ratio (PLR) was 9.13 (95% CI: 6.36-13.12), the combined negative likelihood ratio (NLR) was 0.24 (95% CI: 0.18-0.33), and the diagnostic odds ratio (DOR) was 43.83 (95% CI: 27.12-70.84). The area under the summary receiver operating characteristic (sROC) curve (AUC) was 0.9274, and the Q* value was 0.8621. Regarding sensitivity analyses, the results of this study were relatively stable, and the diagnostic test Deeks funnel plot demonstrated that there was no publication bias in this study.
CTCs have relatively high sensitivity, specificity and accuracy in the diagnosis of gastric cancer patients, which has certain value for the clinical diagnosis of gastric cancer.
为寻找与胃癌诊断相关的新生物标志物，近年来，一些研究人员证实循环肿瘤细胞（CTCs）可用于胃癌诊断，但研究结果并不一致。在本研究中，我们采用荟萃分析系统评价CTCs对胃癌的诊断价值。
使用以下数据库进行全面检索：PubMed、Embase、Cochrane图书馆、Web of Science、Ovid MEDLINE、Scopus、中国知网（CNKI）、万方、维普中文数据库、中国生物医学文献数据库（CBM）和读秀数据库。此次广泛检索的目的是查找已发表的研究，这些研究探讨了CTCs在胃癌诊断中的作用，特别是在胃癌和非胃癌患者中的作用。检索范围涵盖各数据库建库起始至2025年1月30日。随后，对符合条件的研究进行严格筛选。根据一组预先确定的文献纳入和排除标准对其进行评估。使用诊断准确性研究质量评估-2（QUADAS-2）量表对纳入文献的质量进行评估，该量表是一种用于评估癌症研究领域研究质量的工具。然后提取相关数据，并使用MetaDiSc 1.4和Stata 16.0软件对纳入研究进行荟萃分析。
本研究共纳入18篇论文，涉及1399例胃癌患者和750例非胃癌对照。荟萃分析表明，纳入论文的异质性是由非阈值效应引起的。Meta回归分析显示，检测方法的差异可能是异质性的主要来源。随机效应模型分析显示，基于细胞的CTCs检测诊断胃癌的合并敏感度为0.78 [95%置信区间（CI）：0.76-0.80]，合并特异度为0.93（95%CI：0.91-0.94），合并阳性似然比（PLR）为9.13（95%CI：6.36-13.12），合并阴性似然比（NLR）为0.24（95%CI：0.18-0.33），诊断比值比（DOR）为43.83（95%CI：27.12-70.84）。汇总受试者工作特征（sROC）曲线下面积（AUC）为0.9274，Q*值为0.8621。在敏感性分析方面，本研究结果相对稳定，诊断试验的Deeks漏斗图表明本研究不存在发表偏倚。
CTCs对胃癌患者具有较高的敏感度、特异度和准确性，对胃癌的临床诊断具有一定价值。
