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目的系统性评价CellSearch检测循环肿瘤细胞在转移性乳腺癌患者预后中的作用。方法检索PubMed、EMbase、Cochrane图书馆、中国期刊全文数据库(CNKI)及中国生物医学文献数据库(CBM)等,收集CellSearch检测循环肿瘤细胞(CTCs)对转移性乳腺癌患者预后的研究。以无进展生存期(PFS)和总生期(OS)为观察终点,ReviewManager5.1进行Meta分析。结果19篇英文文献包含3710例转移性乳腺癌患者纳入荟萃分析,分析结果显示CTCs阳性组与肿瘤转移灶数目增加呈强相关(OR=1.53,95%CI:1.26~1.85)。与肿瘤原发灶HER2+(OR=1.15,95%CI:0.62~2.13),肿瘤分级(OR=1.68,95%CI:0.55~5.14),肿瘤治疗(OR=0.89,95%CI:0.72~1.11)无相关性。CTC阳性组较阴性组在PFS(HR=1.67,95%CI:1.44~1.92)、OS(HR=2.80,95%CI:2.32~3.37)上均有统计学意义(P<0.05),根据不同的标本采集时间进行亚组分析,CTC阳性组均比CTC阴性患者预后差。结论CellSearch System检测CTCs用来预测转移性乳腺癌患者预后,其中,CTC阳性组是肿瘤的转移的风险因素,基线及治疗前CTC阳性组均预示转移性乳腺癌患者预后不良,敏感性分析和漏斗图分析结果提示该研究结果可信度高。
Objective To systematically evaluate the role of CellSearch in detecting circulating tumor cells in the prognosis of patients with metastatic breast cancer. Methods PubMed, EMbase, Cochrane Library, CNKI and CBM were searched to investigate the prognosis of patients with metastatic breast cancer by CellSearch in detecting circulating tumor cells (CTCs). The progression-free survival (PFS) and total life (OS) were the endpoints of review, and ReviewManager5.1 was used for meta-analysis. Results Nineteen English articles including 3710 cases of metastatic breast cancer were included in the meta-analysis. The results showed that there was a strong correlation between the number of metastatic tumor and CTCs positive group (OR = 1.53, 95% CI: 1.26-1.85). (OR = 1.15, 95% CI: 0.62 ~ 2.13), tumor grade (OR = 1.68, 95% CI: 0.55-5.144), tumor treatment (OR = 0.89, 95% CI: 0.72-1.11 No correlation. The CTC positive group had statistically significant (P <0.05) PFS (HR = 1.67,95% CI: 1.44-1.92) and OS (HR = 2.80,95% CI: 2.32-3.37) Of the specimen collection time for subgroup analysis, CTC positive group than CTC negative patients with poor prognosis. Conclusion The CTCs were detected by CellSearch System in predicting the prognosis of patients with metastatic breast cancer. CTC positive patients were the risk factors of tumor metastasis. Both baseline and pre-treatment CTC positive patients predicted the prognosis of patients with metastatic breast cancer. Sensitivity analysis and funnel Graph analysis results suggest that the results of this study have high credibility.