循环肿瘤细胞对结直肠癌预后价值的meta分析

发布时间：2018-06-23 21:04

  本文选题：循环肿瘤细胞 + 结直肠癌　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的结直肠癌(colorectalcancer,CRC)是世界范围内最常见的发病率和死亡率较高的恶性肿瘤之一。部分研究表明循环肿瘤细胞(circulating tumor cells,CTCs)对结直肠癌具有预后价值,但还有部分研究表明其不存在预后价值,目前其预后价值存在争议。此研究通过meta分析评估循环肿瘤细胞与结直肠癌患者预后的关系。方法通过检索 PubMed,Medline 和 ISI Web of Science 数据库(截至 2017 年 2 月),根据纳入和排除标准,有关循环肿瘤细胞与结直肠癌预后关系的文献入选本研究。所有统计分析在Review Manager 5.3和STATA14.0软件中完成。通过计算合并总生存期(overall survival,OS)和无进展生存期(progression free survival,PFS)的风险比(hazard ratios,HRs)及相应的 95%置信区间(confidence interval,CI),转移相关的比值比(oddsratio,OR),治疗反应的危险比(riskratio,RR)等进行数据分析。结果本meta分析纳入23个研究的6371例结直肠癌患者。与CTCs阴性患者相比,CTCs 阳性患者总生存期(OS:HR = 2.22,95%CI[1.76,2.82],P0.01,I2 = 58%)及无进展生存期(PFS:HR= 1.80,95%CI[1.52,2.14],P=0.04,I2 = 48%)均缩短,二者均具有统计学差异。在转移阳性组CTCs的检出率明显高于转移阴性组(OR =4.13,95%CI[1.78,9.57],P0.01,I2 = 0%)。有肝转移的患者,CTCs 的检出率明显高于肝转移阴性的患者(OR=2.72,95%CI[1.90,3.89],P0.01,I2 = 0%)。3 篇研究纳入治疗有效率的meta分析,CTCs阳性组的有效率与CTC阴性组无明显差异(RR = 0.78,95%CI[0.78,1.02],P = 0.067,12 = 28.8%)。3 篇研究纳入肿瘤控制率的meta分析,结直肠癌患者中CTCs阴性的患者相比于CTCs阳性的患者有更高的疾病控制率(RR = 0.89,95%CI[0.82,0.97],P = 0.008,12= 96.2%)。结论此meta分析预示着在结直肠癌患者外周血中CTCs有预后价值,CTCs阳性的结直肠癌比CTCs阴性的结直肠癌预后更差。此外,CTCs阴性预示着更高的疾病控制率,能够为肿瘤影像学提供额外的预后信息,可能作为对化疗反应新的替代预测标志物。
[Abstract]:Objective Colorectal cancer (CRC) is one of the most common malignant tumors with high morbidity and mortality worldwide. Some studies have shown that circulating tumor cells (circulating tumor cells have prognostic value for colorectal cancer, but others have shown that it does not have prognostic value, and its prognostic value is controversial at present. This study assessed the relationship between circulating tumor cells and prognosis of colorectal cancer patients by meta analysis. Methods by searching the PubMedline and ISI Web of Science databases (up to February 2017), the literature on the relationship between circulating tumor cells and the prognosis of colorectal cancer was included in this study according to the inclusion and exclusion criteria. All statistical analysis is performed in the Review Manager 5.3 and STATA14.0 software. The data were analyzed by calculating the hazard ratio (hazard / HRs), the corresponding 95% confidence interval (confidence / CI), the metastatic correlation ratio (oddsratioor) and the risk ratio of therapeutic response (RiskratioRR) for overall survival OS and (progression free survival without progression. Results the meta analysis included 6371 patients with colorectal cancer in 23 studies. Compared with CTCs negative patients, the total survival time (OS: HR = 2.22 / 95 CI [1.76 卤2.82] P 0.01 I _ 2 = 58%) and the progressive survival time (PFS: HR= 1.80 ~ 95CI [1.52 卤2.14] P 0.04I _ 2 = 48%) were significantly shorter than those in CTCs negative patients. The positive rate of CTCs in the metastatic positive group was significantly higher than that in the metastatic negative group (OR 4.1395 CI [1.789.57] P 0.01 I2 = 0%). The positive rate of CTCs in patients with liver metastasis was significantly higher than that in patients with negative hepatic metastasis (CI [1.90 卤3.89] P0.01I _ 2 = 0%). 3 there was no significant difference in the effective rate between CTCs positive group and CTC-negative group (RR = 0.7895 CI [0.781.02] P = 0.067 7 12 = 28.8%). Meta analysis of tumor control rate, Patients with CTCs negative had a higher disease control rate than those with CTCs positive (RR = 0.89V 95 CI [0.82U 0.97] P = 0.00812 = 96.2%). Conclusion this meta analysis indicates that CTCs have prognostic value in peripheral blood of patients with colorectal cancer, and the prognosis of colorectal cancer with positive CTCs is worse than that with CTCs negative. In addition, CTCs negative predict higher disease control rate, which can provide additional prognostic information for tumor imaging, and may be used as a new alternative predictive marker for chemotherapy response.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34
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本文编号：2058433