Abstract
The aim of this study was to analyze the prognostic implications of pretreatment circulating endothelial cells (CECs) and circulating endothelial progenitor cells (CEPCs) for the survival of patients with lung cancer. Relevant literature was identified using Medline and EMBASE. Patient clinical characteristics, overall survival (OS) and progression-free survival (PFS) together with CEC and CEPC positive rates before treatment were extracted. STATA 12.0 was used for our analysis and assessment of publication bias. A total of 13 articles (8 for CEC and 5 for CEPC, n=595 and n=244) were pooled for the global meta-analysis. The odds ratio (OR) for OS predicted by pretreatment CECs was 1.641 [0.967, 2.786], while the OR for PFS was 1.168 [0.649, 2.100]. The OR for OS predicted by pretreatment CEPCs was 12.673 [5.274, 30.450], while the OR for PFS was 4.930 [0.931, 26.096]. Subgroup analyses were conducted according to clinical staging. Odds ratio (OR) showed the high level of pretreatment CECs only correlated with the OS of patients with advanced lung cancer (stage III-IV). High counts of CECs seem to be associated only with worse 1-year OS in patients with lung cancer, while high level of pretreatment CEPCs correlate with both worse PFS and OS.
Highlights
Lung cancer accounts for 12 % of all cancers diagnosed and its high incidence with its low survival rate leads it to be one of the leading causes of cancer death in worldwide (Jemal et al, 2011)
Our electronic search algorithm retrieved a total of 340 references (221 from PubMed and 24 from Embase) for circulating endothelial cells (CECs)/circulating endothelial progenitor cells (CEPCs) (245 for CECs and 95 for CEPCs)and non-small cell lung cancer (NSCLC). 14 reports were identified, while one of which was excluded for lacking informative clinical data (Nowak et al, 2010)
CECs and CEPCs measurements had been done before any treatment
Summary
Lung cancer accounts for 12 % of all cancers diagnosed and its high incidence with its low survival rate leads it to be one of the leading causes of cancer death in worldwide (Jemal et al, 2011). Endothelial progenitor cells (EPCs) are defined as circulating precursor cells with the ability to differentiate to mature endothelial cells, form functional blood vessels, and play a role in promoting abnormal vascularization in neoplastic sites (Melero-Martin et al, 2011) These factors, such as age, male gender, smoking, blood pressure (BP) levels and cardiovascular risk factors, have been reported to reduce the number of circulating EPCs (CEPCs) (Pirro et al, 2006; Pirro et al, 2007; Fadini et al, 2008; Pirro et al, 2008; Yue et al, 2010). The aim of this study was to analyze the prognostic implications of pretreatment circulating endothelial cells (CECs) and circulating endothelial progenitor cells (CEPCs) for the survival of patients with lung cancer. Conclusions: High counts of CECs seem to be associated only with worse 1-year OS in patients with lung cancer, while high level of pretreatment CEPCs correlate with both worse PFS and OS
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