Application of Primary/Secondary Circulating Tumor Cells for the Prediction of Biochemical Recurrence in Nonmetastatic Prostate Cancer Patients following Radical Prostatectomy or Radiotherapy: A Meta-Analysis

Liang Cao,Tao Wu,Tinghui Hu,Shu Cui,Peng Hao,Dong Lin,Yangming Li,Tao Cai,Robert Stoehr

doi:10.1155/2021/4730970

Abstract

Background Circulating tumor cells (CTCs) have been regarded as an independent prognostic marker for metastatic castration-resistant prostate cancer (mCRPC). Its prognostic value, however, in nonmetastatic prostate cancer (NMPC) is still unclear. Purpose To elucidate whether CTCs can predict the biochemical recurrence (BCR) in NMPC patients following radical prostatectomy (RP) or radiotherapy (RT). Methods PubMed, Cochrane Database, and Embase and the references in relevant studies were systematically searched. Studies that investigated the correlation of CTCs and BCR in NMPC patients after RP or RT were identified and reviewed. Overall odds ratio (OR) of BCR in such patients with/without CTCs was pooled. We also calculated and pooled overall prevalence of BCR in such CTC-positive patients. Results In total, 12 studies comprising 1917 participants were eligible for the meta-analysis and showed that the presence of secondary circulating tumor cells (SCTCs) is associated with a higher BCR rate of 59% (95% CI: 22%-88%) in patients with NMPC after RP or RT (OR = 6.12; 95% CI: 2.22-16.85; P < 0.001). However, regardless of the presence of primary circulating tumor cells (PCTCs), it has not been shown to be associated with higher BCR. Conclusions Our research demonstrated that SCTC-positive patients are associated with higher BCR compared to SCTC-negative patients in NMPC. Therefore, it is recommended that NMPC patients undergo CTC surveillance intensively after RP or RT.

Highlights

Both radical prostatectomy (RP) and radiotherapy (RT) are standard therapies for treating nonmetastatic prostate cancer (NMPC) [1]
The flowchart of literature screening and selection results based on the PRISMA statement is shown in Figure 1. 453 records were obtained by a detailed search of the electronic database according to our prespecified search strategy, and 37 were considered potentially suitable
Meta-analysis of extractable data from 12 prospective studies demonstrated that the presence of secondary circulating tumor cells (SCTCs) is associated with a higher biochemical recurrence (BCR) rate of 59% in NMPC patients after RP or RT

Summary

Introduction

Both radical prostatectomy (RP) and radiotherapy (RT) are standard therapies for treating nonmetastatic prostate cancer (NMPC) [1]. BCR is defined as detectable or rising prostate-specific antigen (PSA) value after surgery that is ≥0.2 ng/ml with a second confirmatory level of ≥0.2 ng/ml by the American Urological Association (AUA) [3] It is defined as a rise in PSA to ≥2 ng/ml above nadir PSA after external beam radiotherapy (EBRT) with or without hormonal treatment by the American Society for Radiation Oncology (ASTRO) and Radiation Therapy Oncology Group (RTOG) [4]. 12 studies comprising 1917 participants were eligible for the meta-analysis and showed that the presence of secondary circulating tumor cells (SCTCs) is associated with a higher BCR rate of 59% (95% CI: 22%-88%) in patients with NMPC after RP or RT (OR = 6:12; 95% CI: 2.2216.85; P < 0:001). It is recommended that NMPC patients undergo CTC surveillance intensively after RP or RT

Methods

Results

Conclusion