摘要
目的探讨外周血循环肿瘤细胞(CTCs)预测肝细胞癌患者的临床预后价值。方法计算机检索PubMed、EMBase、Web of Science、Cochrane Library、CISCOM、CINAHL、Google学术、中国生物医学文献数据库(CBM)和中国知网等中英文数据库。检索时间从建库至2013-08-01,采用STATA 12.0软件进行Meta分析,计算危险比(HR)及其95%可信区间(95%CI)评价CTCs预测肝细胞癌患者临床预后的价值。结果共纳入12项对列研究,包括1 133例肝细胞癌患者,其中CTCs阳性患者559例和CTCs阴性患者574例。Meta分析结果显示:CTCs阳性患者的总生存期(OS)和无复发生存期(RFS)短于CTCs阴性患者〔OS:HR=1.53,95%CI(0.98,2.07),P<0.001;RFS:HR=3.14,95%CI(0.70,5.58),P=0.012〕。CTCs阳性患者与CTCs阴性患者的无病生存期(DFS)差异无统计学意义〔HR=1.35,95%CI(-0.75,3.46),P=0.207〕。欧美人群和亚洲人群CTCs阳性患者OS与RFS均短于CTCs阴性患者〔欧美人群:HR=2.09,95%CI(1.29,2.89),P<0.001;亚洲人群:HR=1.14,95%CI(0.65,1.64),P<0.001〕。CTCs阳性的原发性和继发性肝细胞癌患者OS与RFS均短于CTCs阴性患者〔原发性肝细胞癌:HR=1.14,95%CI(0.70,1.57),P<0.001;继发性肝细胞癌:HR=2.54,95%CI(1.54,3.55),P<0.001〕。在qRT-PCR和CellSearch亚组中CTCs阳性患者OS与RFS均短于CTCs阴性患者〔qRT-PCR:HR=1.36,95%CI(0.87,1.86),P<0.001;CellSearch:HR=2.57,95%CI(1.19,3.94),P<0.001〕。结论 CTCs阳性肝细胞癌患者的OS和RFS均劣于CTCs阴性患者。检测外周血中CTCs对判断肝细胞癌的临床预后具有重要意义。
Objective To assess the prognostic value of circulating tumor cells （CTCs） in predicting the prognosis of patients with hepatocellular carcinoma （HCC） . Methods An extensive literary search for relevant studies was conducted on PubMed, EMBase, Web of Science, Cochrane Library, CISCOM, CINAHL, Google Scholar, CBM and CNKI databases from their inception through August 1st, 2013. STATA 12. 0 software was used to conduct Meta analysis, HR and 95% C1 were calcu- lated to assess the prognostic value of CTCs in HCC patients. Results Twelve cohort studies were included in this Meta analysis with a total of 1 133 HCC patients, including 559 patients in the CTCs - positive group and 574 patients in the CTCs - negative group. Our Meta analysis revealed that HCC patients in the CTCs - positive group was significantly associated with poor overall sur- vival lOS： HR=l.53, 95%C1 （0.98, 2.07）, P〈0.001; RFS： HR =3.14, 95%CI （0.70, 5.58）, P=0.012]. However, there was no significant difference in disease - free survival （DFS） between the CTCs - positive and CTCs - negative groups [ HR = 1.35, 95% CI （ -0. 75, 3.46）, P = 0. 207] . A subgroup analysis by ethnicity suggested that CTCs -positive patients showed worse prognosis than CTCs - negative patients among both Asian and Caucasian populations （ Caucasian： HR = 2.09, 95%C1（1.29, 2.89）, P〈0.001; Asian： HR=1.14, 95%CI（0.65, 1.64）, P〈0. 001] ,Furthersubgroupana- lyses by diagnosis showed that the prognosis of CTCs - positive patients was worse than CTCs - negative patients in both primary HCC and secondary HCC [ primary HCC： HR = 1.14, 95% CI （0. 70, 1.57） , P 〈 0. 001 ; secondary HCC： HR = 2. 54,95% C1 （ 1.54, 3.55 ） , P 〈 0. 0013 . Furthermore, subgroup analyses by detection methods revealed that there were statistical- ly significant differences between CTCs -positive patients and CTCs -negative patients in both qRT- PCR and CellSearch meth- ods （qRT-PCR： HR=l.36, 95%CI （0.87, 1.86）, P〈0.001; CellSearch： HR=2.57, 95%C1 （1.19, 3.94）, P〈 0. 001 ~ . Conclusion The Meta analysis suggests that CTCs - positive HCC patients may have worse OS and RFS than CTCs - negative patients. Detection of CTCs in peripheral blood may be a promising biomarker for the detection and prognosis of HCC.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第12期1394-1399,共6页
Chinese General Practice
关键词
癌
肝细胞
循环肿瘤细胞
预后
META分析
Carcinoma, hepatocellular
Circulating tumor cells
Prognosis
Meta-analysis
