Xu HT, Miao J, Liu JW, Zhang LG, Zhang QG. Prognostic value of circulating tumor cells in esophageal cancer. World J Gastroenterol 2017; 23(7): 1310-1318 [PMID: 28275311 DOI: 10.3748/wjg.v23.i7.1310]
Corresponding Author of This Article
Qing-Guang Zhang, MD, Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, No. 661, Huanghe Erlu, Binzhou 256603, Shandong Province, China. drzhangqingg@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hai-Tao Xu, Jian-Wei Liu, Lian-Guo Zhang, Qing-Guang Zhang, Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China
Jing Miao, Department of Neonatal Intensive Care Unit, Binzhou People’s Hospital, Binzhou 256603, Shandong Province, China
Author contributions: Xu HT and Miao J contributed equally to this work as co-first authors; Xu HT designed the research, analyzed the data and wrote the manuscript; Miao J designed the research, analyzed the data and wrote the manuscript; Liu JW performed the research and contributed analytical tools; Zhang LG performed the research; Zhang QG conceived and designed the research, and revised the manuscript as corresponding author.
Conflict-of-interest statement: The authors declare that this is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qing-Guang Zhang, MD, Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, No. 661, Huanghe Erlu, Binzhou 256603, Shandong Province, China. drzhangqingg@126.com
Telephone: +86-543-3258731 Fax: +86-543-3257792
Received: December 19, 2016 Peer-review started: December 21, 2016 First decision: January 10, 2017 Revised: January 20, 2017 Accepted: February 7, 2017 Article in press: February 8, 2017 Published online: February 21, 2017
Abstract
AIM
To perform a meta-analysis of the related studies to assess whether circulating tumor cells (CTCs) can be used as a prognostic marker of esophageal cancer.
METHODS
PubMed, Embase, Cochrane Library and references in relevant studies were searched to assess the prognostic relevance of CTCs in patients with esophageal cancer. The primary outcome assessed was overall survival (OS). The meta-analysis was performed using the random effects model, with hazard ratio (HR), risk ratio (RR) and 95% confidence intervals (95%CIs) as effect measures.
RESULTS
Nine eligible studies were included involving a total of 911 esophageal cancer patients. Overall analyses revealed that CTCs-positivity predicted disease progression (HR = 2.77, 95%CI: 1.75-4.40, P < 0.0001) and reduced OS (HR = 2.67, 95%CI: 1.99-3.58, P < 0.00001). Further subgroup analyses demonstrated that CTCs-positive patients also had poor OS in different subsets. Moreover, CTCs-positivity was also significantly associated with TNM stage (RR = 1.48, 95%CI: 1.07-2.06, P = 0.02) and T stage (RR = 1.44, 95%CI: 1.13-1.84, P = 0.003) in esophageal cancer.
CONCLUSION
Detection of CTCs at baseline indicates poor prognosis in patients with esophageal cancer. However, this finding relies on data from observational studies and is potentially subject to selection bias. Prospective trials are warranted.
Core tip: The clinical validity of circulating tumor cells (CTCs) is still controversial and inconclusive in patients with esophageal cancer. Our meta-analysis provides strong evidence that detection of CTCs in peripheral blood at baseline is an independent prognosticator of poor survival outcomes in esophageal cancer patients.
