CellSearch检测循环肿瘤细胞对转移性乳腺癌预后的Meta分析

The prognostic role of circulating tumor cells detected by Cell Search system in metastatic breast cancer: a Meta-analysis

目的系统性评价CellSearch检测循环肿瘤细胞在转移性乳腺癌患者预后中的作用。方法检索PubMed、EMbase、Cochrane图书馆、中国期刊全文数据库（CNKI）及中国生物医学文献数据库（CBM）等，收集CellSearch检测循环肿瘤细胞（CTCs）对转移性乳腺癌患者预后的研究。以无进展生存期（PFS）和总生期（OS）为观察终点，ReviewManager5．1进行Meta分析。结果19篇英文文献包含3710例转移性乳腺癌患者纳入荟萃分析，分析结果显示CTCs阳性组与肿瘤转移灶数目增加呈强相关（OR=1．53，95％CI：1．26～1．85）。与肿瘤原发灶HER2’（OR=1．15，95％CI：0．62～2．13），肿瘤分级（OR=1．68，95％C1：0．55～5．14），肿瘤治疗（OR=O．89，95％CI：0．72～1．11）无相关性。CTC阳性组较阴性组在PFS（HR=1．67，95％C1：1．44～1．92）、OS（且R=2．80，95％（21：2．32～3．37）上均有统计学意义（P〈0．05），根据不同的标本采集时间进行亚组分析，CTC阳性组均比CTC阴性患者预后差。结论CellSearchSystem检测CTCs用来预测转移性乳腺癌患者预后，其中，CTC阳性组是肿瘤的转移的风险因素，基线及治疗前CTC阳性组均预示转移性乳腺癌患者预后不良，敏感性分析和漏斗图分析结果提示该研究结果可信度高。

Objective This analysis was undertaken to evaluate the prognostic role of CellSearch system-detected circulating tumor ceil （CTC） in metastatic .breast cancer. Methods Trials using CellSearch system-detected CTC to predict the prognosis of patients with metastatic breast cancer were searched though the PubMed, EMbase, Cochrane library, China National Knowledge infrastructure （CNKI）, and Chinese Biomedical Literature Database （CBM）. Progression-free survival （PFS） and overall survival （OS） were main outcome measures. Review Manager 5.2.7 was used for this analysis. Results The final pooling dataset had a total of 3 710 patients from 19 studies. CTCs positive group showed a significant correlation with the number of tumor metastases （0R=1.53, 95% CI： 1.26-1.85）, rather than primary tumor HER2＋ （OR=l.15, 95% CI： 0.62-2.13）, tumor grade （0R=1.68, 95% CI： 0.55-5.14）, and tumor treatment （OR=0.89, 95% CI： 0.72-1.11）. The CTC positive group, as compared with the control group, demonstrated statistical significance in both PFS （HR=l.67, 95% CI： 1.44-1.92） and OS （HR=2.80, 95% CI： 2.32-3.37）. Stratification by different sampling time showed poorer prognosis in the CTC positive group compared to the control group （P〈0.05）. Conclusion The analysis reveals that CelSearch system-detected CTC predicts a poor prognosis of metastatic breast cancer and positive CTC may represent a risk factor for this metastasis. Sensitivity analysis and the funnel plots have validated the reliability of the combined estimates.