Abstract
We performed a meta-analysis of CD133-related clinical data to investigate the role of cancer stem cells (CSCs) in the clinical outcomes of colorectal cancer (CRC) patients, analyzing the effectiveness of various therapeutic strategies and examining the validity of the CSC hypothesis. For 28 studies (4546 patients), the relative risk (RR) to survival outcomes associated with CD133+ CRCs were calculated using STATA 12.0 software. Pooled results showed that CD133High patients had poor 5-year overall survival (RR 0.713, 95% CI 0·616–0·826) and 5-year disease free survival (RR 0·707, 95% CI 0·602–0·831). Both associations were consistently observed across different races, research techniques and therapeutic strategies. In a subgroup receiving adjuvant therapy, CD133Low patients achieved significantly better survival than CD133High patients. The findings suggest that CD133 could serve as a predictive marker of poor prognosis and treatment failure in CRC. CD133Low patients could benefit from adjuvant treatments, while CD133High patients should be given novel treatments besides adjuvant therapy. Our results also provide evidence in support of the CSC hypothesis.
Highlights
Cancer stem cells (CSCs), called tumorinitiating cells, are a small subpopulation of multipotent cancer cells with the capacity to self-renew [1, 2]
23 studies comprising 1157 CD133High patients and 2344 CD133Low patients were included in the analyses of overall survival (OS), while 15 studies including 533 CD133High patients and 1087 CD133Low patients provided relevant outcomes of disease free survival (DFS)
Additional relevant reports may have appeared while we completed this study. This meta-analysis showed that a high level of the CSC marker CD133 was significantly correlated with poor DFS and OS in colorectal cancer (CRC) patients
Summary
Cancer stem cells (CSCs), called tumorinitiating cells, are a small subpopulation of multipotent cancer cells with the capacity to self-renew [1, 2]. According to the CSC hypothesis, these stem-like cells play a pivotal role in tumorigenesis, metastasis and relapse [1,2,3,4]. Previous work showed that only CSCs could reconstitute tumors with similar histopathological characteristics to the primary cancer, whereas non-stem cancer cells failed to effect tumor initiation [1, 5, 6]. Cancer stem cells were shown to be involved in the process of tumor invasion, metastasis and resistance to conventional therapy, which were underlying factors in tumor recurrence and treatment failure [7,8,9]. Clinical evidence of tumor formation by CSCs in humans, difficult to observe, would further validate the CSC hypothesis. Through a comprehensive meta-analysis of published CSC-related research, we evaluated whether current clinical evidence supported the CSC hypothesis
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