骨髓微转移肿瘤细胞预测乳腺癌患者预后的Meta分析

A Meta-analysis of disseminating tumor cells in bone marrow predicting prognosis of patients with breast cancer

目的:系统性评价骨髓中微转移肿瘤细胞(disseminating tumor cell,DTC)在乳腺癌患者预后预测中的作用。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,收集DTC预测乳腺癌患者预后的研究,以无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)为观察终点,采用Review Manager 5.1.4进行Meta分析。结果:14篇英文文献包含4 091例乳腺癌患者纳入荟萃分析。结果提示DTC阳性组较阴性组在PFS[HR=1.83(95%CI:1.51～2.22),n=12,I2=75%]和OS[HR=1.59(95%CI:1.39～1.83),n=12,I2=58%]上均有统计学差异(P<0.000 01)。根据检测时间不同进行亚组分析,结果提示术前、术中和术后组DTC阳性的乳腺癌患者比DTC阴性者预后差;根据检测方法不同进行亚组分析,用免疫细胞化学(immunocytochemistry,ICC)或逆转录定量聚合酶链反应(reverse transcriptanse quantitative polymerasechain reaction,RT-qPCR)方法检测DTC阳性与其阴性者相比,预后差异均有统计学意义(P<0.000 01)。结论:术前、术中和术后DTC阳性的乳腺癌患者较DTC阴性者预后差。

Objective：To evaluate the prognostic relevance of disseminating tumor cells（DTCs） detection in the bone marrow of patients with breast cancer.Methods：The literature was searched from Medline,Embase,China National Knowledge Infrastructure（CNKI）,Wanfang Data and VIP information database.Review Manager 5.1.4 was used for Meta-analysis and main outcome measures included progression-free survival（PFS） and overall survival（OS）.Results：A total of 4 091 patients from 14 studies were enrolled.Meta-analysis associated the presence of DTCs with both poor PFS [HR=1.83（95%CI：1.51～2.22）,n = 12,I2 = 75%]and OS [HR= 1.59（95%CI：1.39～1.83）,n = 12,I2 = 58%].The subgroup analyses on different sampling time showed that the detection of DTCs was a potential prognostic factor before,during and after operation.Stratification by different detection methods also showed that there were statistically significant differences in PFS and OS between DTCs-positive patients and DTCs-negative ones both in iICC（immuno cytochemistry） and RT-（q）PCR（reverse transcriptionanse quantitative polymerase chain reaction） compartment（P 0.000 01）.Conclusion：The presence of DTCs before,during and after operation indicates early recurrence and death in breast cancer patients.