| Objective: To summarize the literature on the application of circulating tumor cells(CTC)in the diagnosis of colorectal cancer(CRC),to clarify the specific diagnostic value of CTC independent of circulating tumor DNA(ct DNA),and to compare the best CTC detection markers.Methods: Keywords were searched in Pub Med,Embase and Cochrane,and the search time was set from January 1,2002 to December 1,2022.Literatures were strictly screened according to inclusion and exclusion criteria,and Stata17,Metadisc1.4 and other software were used to merge effect sizes and test heterogeneity.Results: A total of 65 literatures were included in this meta-analysis.The specific diagnostic sensitivity and specificity of CTCS were 0.69(95%CI: 0.62-0.76),0.96(95%CI: 0.93-0.98)and 0.92(95%CI: 0.99-0.94),respectively.In addition,the sensitivity and specificity of CTCS in early colorectal cancer were 0.52(95%CI:0.42-0.62),0.97(95%CI: 0.94-0.99),and 0.87(95%CI: 0.84-0.9).In order to compare the best circulating tumor cell detection markers,complete data were collected for 24 markers individually.In order to ensure the reliability of the results,only the markers reported in 5 or more literatures were combined and compared.Finally,4 markers met the comparison criteria,respectively EPCAM,CEA,CK19 and CK20.The sensitivity was 0.81(95%CI: 0.67-0.89),0.67(95%CI: 0.5-0.81),0.66(95%CI:0.44-0.83),and0.53(95%CI: 0.43-0.64),respectively.The specificity was 0.98(95%CI: 0.74-1),0.93(95%CI: 0.86-0.97),0.94(95%CI: 0.64-0.99),0.93(95%CI: 0.85-0.97).The AUC areas were 0.93(95%CI: 0.99-0.95),0.92(95%CI: 0.89-0.94),0.87(95%CI: 0.84-0.9),and 0.79(95%CI: 0.75-0.82),respectively.For the combined detection of multiple markers,only EPCAM+CK met the requirements of comparison,and its sensitivity and specificity were 0.52(95%CI:0.33-0.71)and 0.98(95%CI: 0.83-1),respectively.The AUC was 0.9(95%CI: 0.87-0.92).In addition,a new detection method for CTC,namely,negative enrichment combined with fluorescence in situ hybridization for aneuploidy detection,also has good diagnostic value,and its sensitivity and specificity are 0.81(95%CI: 0.74-0.86)and 0.99(95%CI: 0.72-1),respectively.The AUC was 0.88(95%CI: 0.85-0.9).In the heterogeneity test,the time of publication is the main source of heterogeneity for multiple studies.Conclusions: CTC have considerable specific diagnostic value,even in early colorectal cancer has a high sensitivity.The best detection marker of CTC is EPCAM alone,while the advantages of combined detection cannot be reflected due to the number of studies.In terms of detection methods,the technique of detecting aneuploidy by immunomagnetic bead negative enrichment combined with fluorescence in situ hybridization,which has been studied more frequently in recent years,has proved to have good diagnostic value. |
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