Breast Cancer Res Treat 2011 Dec;130 (3): 809-16. [IF:4.859]
The prognostic role of circulating tumor cells (CTCs) detected by RT-PCR in breast cancer: a meta-analysis of published literature.
Zhao S , Liu Y , Zhang Q , Li H , Zhang M , Ma W , Zhao W , Wang J , Yang M .
Department of Internal Medicine, The Third Affiliated Hospital of Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China.
哈尔滨医科大学附属第三医院
Abstract
The prognostic significance of circulating tumor cells (CTCs) in patients with breast cancer is controversial. We performed a meta-analysis of published literature to assess whether the detection of CTCs in patients diagnosed with primary breast cancer can be used as a prognostic factor. We searched Medline, Science Citation Index, and Embase databases as well as reference lists of relevant articles (including review articles) for studies that assessed the prognostic relevance of tumor cell detection in the peripheral blood (PB). A total of 24 eligible studies with 4,013 cases and 1,333 controls were included. Meta-analyses were performed using a random-effects model, using the hazard ratio (HR) and 95% confidence intervals (95% CIs) as effect measures. The positive detection of CTCs in patients was significantly associated with poor overall survival (OS) (HR = 3.00 [95% CI 2.29-3.94], n = 17, P < 0.0001) and recurrence-free survival (RFS) (HR = 2.67 [95% CI 2.09-3.42], n = 22, P < 0.0001). CTC-positive breast cancers were significantly associated with high histological grade (HR = 1.21 [95% CI 1.09-1.35], n = 34, P < 0.0001), tumor size (>2 cm) (HR = 1.12 [95% CI 1.02-1.22], n = 31, P = 0.01). and nodal status (≥1) (HR = 1.10 [95% CI 1.00-1.21], n = 32, P = 0.037), but cytokeratin-19 (CK-19) mRNA-positive CTCs were not associated with these clinicopathological parameters of breast cancer. Furthermore, the presence of CTCs was not associated with estrogen receptor (ER) negativity, progesterone receptor (PR) negativity, or human epidermal growth factor receptor type 2 (HER2) positivity. Detection of CTCs in the PB indicates poor prognosis in patients with primary breast cancer. Larger clinical studies are required to further evaluate the role of these markers in clinical practice.
摘要：
乳腺癌患者循环中肿瘤细胞（CTCs）的预后意义一直备受争议。我们对已经发表的文献进行了Meta分析，以评估是否可以通过检测CTCs作为诊断原发性乳腺癌的预示因子。我们搜索了Medline、科学引文索引和Embase数据库以及相关文献的参考文献列表（包括综述），以研究评估外周血（PB）中的肿瘤细胞作为预示乳腺癌的相关性。总共有24篇符合条件的研究文献，包括了实验组4013例和对照组1333例研究对象。Meta分析采用随机效应模型，使用危险比（HR）和95％置信区间（95％CIs）作为有效测量指标。患者血循环中CTCs的阳性检测率与较低的整体存活率（OS）（HR=3.00 [95％CI为2.29-3.94]，N= 17，P<0.0001）和无复发生存率（RFS）（HR=2.67 [95％CI为2.09-3.42]，N =22，P <0.0001）密切相关。CTC阳性的乳腺癌患者与组织学分级较高有显著相关性（HR=1.21[95％CI为1.09-1.35]，N=34，P<0.001），肿瘤大小（> 2厘米）（HR=1.12 [95％CI：1.02-1.22]，N=31，P=0.01）。淋巴结状况(≥1) (HR = 1.10 [95% CI为1.00-1.21], n = 32, P = 0.037),但是细胞角蛋白-19（CK-19）mRNA-阳性CTCs与乳腺癌的这些临床病理参数不相关。此外，CTCs的存在与雌激素受体（ER）阴性、孕激素受体（PR）阴性，以及人表皮生长因子受体2（HER2）阳性不相关。检测外周血中的CTCs对原发性乳腺癌的诊断预示作用不明显。因此还需要较多的临床研究，以进一步评估这些标志物在临床实践中的作用。
