Abstract
BackgroundThe prognostic value of circulating tumor cells (CTCs) in colorectal cancer (CRC) patients and their value in predicting tumor response to chemotherapy are controversial. The aim of this meta-analysis was to assess the prognostic and predictive value of CTCs in CRC patients treated with chemotherapy.MethodsA comprehensive literature search for relevant studies was conducted in PubMed, Embase, the Cochrane Database, the Science Citation Index and the Ovid Database, and the reference lists of relevant studies were also perused for other relevant studies (up to April, 2014). Using the random-effects model in Stata software, version 12.0, the meta-analysis was performed using odds ratios (ORs), risk ratios (RRs), hazard ratios (HRs) and 95% confidence intervals (CIs) as effect measures. Subgroup and sensitivity analyses were also performed.ResultsThirteen eligible studies were included. Our meta-analysis indicated that the disease control rate was significantly higher in CRC patients with CTC-low compared with CTC-high (RR = 1.354, 95% CI [1.002–1.830], p = 0.048). CRC patients in the CTC-high group were significantly associated with poor progression-free survival (PFS; HR = 2.500, 95% CI [1.746–3.580], p < 0.001) and poor overall survival (OS; HR = 2.856, 95% CI [1.959–4.164], p < 0.001). Patients who converted from CTC-low to CTC-high or who were persistently CTC-high had a worse disease progression (OR = 27.088, 95% CI [4.960–147.919], p < 0.001), PFS (HR = 2.095, 95% CI [1.105–3.969], p = 0.023) and OS (HR = 3.604, 95% CI [2.096–6.197], p < 0.001) than patients who converted from CTC-high to CTC-low.ConclusionsOur meta-analysis indicates that CTCs are associated with prognosis in CRC patients treated with chemotherapy. Moreover, CTCs could provide additional prognostic information to tumor radiographic imaging and might be used as a surrogate and novel predictive marker for the response to chemotherapy.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-976) contains supplementary material, which is available to authorized users.
Highlights
The prognostic value of circulating tumor cells (CTCs) in colorectal cancer (CRC) patients and their value in predicting tumor response to chemotherapy are controversial
Search strategy PubMed, Embase, the Science Citation Index, Cochrane Database and the Ovid Database were systematically searched for studies of the prognostic and predictive significance of CTCs in CRC patients treated with chemotherapy, with no restrictions on language, place of publication or date of publication
Study eligibility criteria Studies were considered eligible if they met all of the following criteria: (1) all enrolled patients (>20) were diagnosed with CRC; (2) prognostic and predictive significance of CTCs in patients treated with chemotherapy was assessed with at least one of the outcome measures of interest reported in the study or calculated from the published data; (3) tumor response to chemotherapy was assessed according to the Response Evaluation Criteria In Solid Tumors (RECIST) guidelines [13]; and (4) the samples were collected from peripheral blood
Summary
The prognostic value of circulating tumor cells (CTCs) in colorectal cancer (CRC) patients and their value in predicting tumor response to chemotherapy are controversial. 50% of CRC patients will develop subsequent metastasis or recurrence, regardless of curative resection. Despite these outcomes, standard combined chemotherapy has been successfully used to increase the cure rate [2,3]. There are a lack of accurate markers for predicting tumor response that can be used to identify those patients who might safely discontinue prolonged treatment and those who should resume chemotherapy quickly. Such markers could reduce the use of chemotherapy in nonresponsive patients, reducing unnecessary costs and toxicity [8,9]
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