Abstract
BackgroundThe prognostic value of circulating tumor cells (CTCs) detected with the CellSearch System in patients with colorectal cancer (CRC) is controversial. The aim of our meta-analysis was to evaluate whether the detection of CTCs in the peripheral blood with the standardized CellSearch System has prognostic utility for patients with CRC.MethodsThe PubMed, Science Citation Index, Cochrane Database, Embase, and the references in relevant studies were systematically searched (up to December, 2014). No search restrictions were imposed. Our meta-analysis was performed in Stata software, version 12.0 (2011) (Stata Corp, College Station, TX, USA), with the odds ratio (OR), risk ratio (RR), hazard ratio (HR), and 95% confidence interval (95% CI) as the effect measures. Subgroup and sensitivity analyses were also conducted.ResultsEleven studies containing 1847 patients with CRC were analyzed. There was a significantly higher incidence of CTCs in the metastasis-positive group than in the metastasis-negative group (OR = 4.06, 95% CI [1.74, 9.50], P < 0.01, I2 = 0%). For hepatic metastasis, a type of metastasis, a higher incidence of CTCs was observed in the hepatic-metastasis-positive group than in the -negative group (OR = 2.61, 95% CI [1.73, 3.96], P < 0.01, I2 = 0%). The presence of CTCs was significantly related to overall survival (HR = 2.00, 95% CI [1.49, 2.69], P < 0.01, I2 = 67.1%) and progression-free survival (HR = 1.80, 95% CI [1.52, 2.13], P < 0.01, I2 = 43.9%) of patients with CRC, regardless of the sampling time. The response rate for the CTC+ groups was significantly lower than that for the CTC− groups at baseline and during treatment (baseline: 33% versus 39%, RR = 0.79, 95% CI [0.63, 0.99], P = 0.04, I2 = 7.0%; during treatment: 17% versus 46%, RR = 0.41, 95% CI [0.22, 0.77], P = 0.01, I2 = 0.0%;).ConclusionsOur meta-analysis indicates that the detection of CTCs in the peripheral blood with the CellSearch System has prognostic utility for patients with CRC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1218-9) contains supplementary material, which is available to authorized users.
Highlights
The prognostic value of circulating tumor cells (CTCs) detected with the CellSearch System in patients with colorectal cancer (CRC) is controversial
A type of metastasis, a higher incidence of CTCs was observed in the hepatic-metastasis-positive group than in the -negative group (OR = 2.61, 95% Confidence intervals (CIs) [1.73, 3.96], P < 0.01, I2 = 0%)
The presence of CTCs was significantly related to overall survival (HR = 2.00, 95% confidence interval (95% CI) [1.49, 2.69], P < 0.01, I2 = 67.1%) and progression-free survival (HR = 1.80, 95% CI [1.52, 2.13], P < 0.01, I2 = 43.9%) of patients with CRC, regardless of the sampling time
Summary
The prognostic value of circulating tumor cells (CTCs) detected with the CellSearch System in patients with colorectal cancer (CRC) is controversial. Several studies have shown that the presence of CTCs in the blood circulation is a poor prognostic indicator of overall survival (OS) and progression-free survival (PFS) in patients with CRC [5,6]. In those studies, the diagnostic methods used to detect CTCs were predominantly reverse transcription–polymerase chain reaction (RT–PCR) [7] and immunocytochemistry (ICC) [8], targeting either tumor-associated genes or antigens. A pooled analysis of available studies that have used the CellSearch System is required to assess the prognostic relevance of CTC detection in the PB of patients with CRC
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