循环肿瘤细胞状态监测食管癌患者疗效的meta分析

Meta-analysis of circulating tumor cell status monitoring efficacy in patients with esophageal cancer

目的探讨循环肿瘤细胞(CTCs)作为食管癌患者疗效监测指标的应用价值。方法通过PubMed、Embase、Cochrane Library、中国知网、万方及中国生物医学文献数据库等检索建库至2020年6月所有关于食管癌患者治疗前后CTCs变化与疗效关系的研究。根据已制订的纳入和排除标准筛选文献并提取数据。以MINORS评价条目为标准对每个纳入的研究进行质量评价,采用Review Manager5.3软件行数据分析。结果共纳入符合标准的文献12篇,包含961例食管癌患者。总体分析显示,治疗后CTCs阳性率明显下降(RR=0.77,95%CI:0.63~0.95,I^(2)=68%,P=0.010)。亚组分析显示,手术治疗不能降低CTCs阳性率,而同步放化疗、其他治疗均可降低CTCs阳性率。治疗后CTCs降低的患者疾病缓解率明显升高(OR=3.40,95%CI:1.50~7.70,I^(2)=0%,P=0.003)。结论CTCs状态可以作为监测治疗效果的指标,并指导食管癌的后续治疗。

Objective To explore the application value of circulating tumor cells(CTCs)as an indicator of therapeutic efficacy in patients with esophageal cancer.Methods Through PubMed,Embase,Cochrane Library,CNKI,WanFang Data and Chinese Biomedical Literature Database,all studies on the relationship between CTCs before and after treatment and curative effect in patients with esophageal cancer were retrieved until June 2020.According to the established inclusion and exclusion criteria,the literature was screened and data were extracted.The quality of each included study was evaluated based on the MINORS evaluation item,and the data analysis was performed using Review Manager5.3 software.Results A total of 12 articles meeting the criteria were included,including 961 patients with esophageal cancer.The overall analysis showed that the positive rate of CTCs decreased significantly after treatment(RR=0.77,95%CI:0.63-0.95,I^(2)=68%,P=0.010).Subgroup analysis showed that surgical treatment cannot reduce the positive rate of CTCs,while concurrent chemoradiation and other treatments can reduce the positive rate of CTCs.After treatment,patients with reduced CTCs had a significantly higher disease remission rate(OR=3.40,95%CI:1.50-7.70,I^(2)=0%,P=0.003).Conclusion CTCs status can be used as an indicator to monitor the treatment effect and guide the follow-up treatment of esophageal cancer.