循环肿瘤细胞与乳腺癌患者预后相关性的Meta分析

Meta-analysis of Circulating Tumor Cells in Breast Cancer Patients

目的:评估循环肿瘤细胞(circulatingtumor cell,CTC)在预测乳腺癌患者预后中的作用。方法:检索Medline、Embase、中国数字化期刊全文数据库(CNKI)、万方数据库及维普全文网中国内外相关文献,收集检测外周血肿瘤细胞在乳腺癌患者预后中的研究,使用Review Manager 5.1.4中的方差倒数法对无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)进行Meta分析。结果:共纳入33篇英文文献,总计5 393例乳腺癌患者。Meta分析结果提示CTC阳性组较CTC阴性组在PFSHR=2.09(95%CI:1.72～2.55),n=23,I^2=57%]和OS[HR=2.49(95%CI:2.18～2.85),n=24,I^2=0]方面差异均有统计学意义(P<0.01)。根据UICC(International Union Against Cancer)肿瘤分期进行亚组分析,结果显示CTC对不同期别肿瘤的PFS和OS也均有预测价值(P<0.01)。结论:外周血CTC阳性的乳腺癌患者与CTC阴性患者相比预后较差,CTC可以作为乳腺癌患者的预后预测指标。

Objective： To assess the role of detecting circulating tumor cells （ CTCs ） in predicting the prognosis of breast cancer patients. Methods： Clinical trials that assessed the prognostic relevance of tumor cell detection in the peripheral blood of breast cancer patients were retrieved from MEDLINE, Embase, China National Knowledge Infrastructure （ CNKI ）, Wanfang Data, and VIP information database. The generic inverse variance in Review Manager 5.1.4 was used for meta-analysis and the main parameters included progression-free survival （PFS） and overall survival （ OS ）. Results： A total of 33 studies including 5,393 patients were eligible for final analyses. Meta-analyses associated the presence of CTCs with both poor PFS [ HR = 2.09 （95% CI： 1.72 to 2.55）, n = 23, 12= 57% ] and OS [ HR = 2.49 （ 95% CI： 2.18 to 2.85 ）, n = 24, P= 0% ]. The subgroup analysis by the International Union Against Cancer Staging showed that CTCs was a statistically significant prognostic factor of stages I to III and stage IV breast cancer patients （ P 〈 0.00001 ）. Conclusion： The presence of CTCs indicates early recurrence and death in patients with breast cancer, and the detection of CTCs can be used to predict prognosis of breast cancer patients.