Circulating Tumor Cells In Breast Cancer Prognosis And Meta-analysis

Background：There were no exact evidence on the efficacy evaluation andprognostic prediction about Circulating Tumor Cells (CTCs) in breast cancer.The purpose of this study is to investigate the relationship of CTCs and breastcancer survival/TNM stage.Method：WesearchedthePubMed (2000.1-2012.12),Central(theCochranecentralregister of control1ed trials)(2012issue3) and manually searched the ASCO,ESMO, SABC Conference Proceedings; The research included all the patients whoreceived the baseline detection of circulating tumor cell. The application ofstatistical software was Stata11.1for data analysis. The including populationwere patients who were diagnosed as breast cancer. All patients underwent thedetection of circulating tumor cells before the treatment. The main outcome wasOverall Survival (OS) and Disease-Free Survival (DFS). The second outcomes werethe dichotomous data about circulating tumor cells and TNM stage. The survivaloutcomes were estimated as hazard ratio（HR） with95%confidence interval(CI).The dichotomous datas were estimated as odds ratio (OR) with95%CI. The outcomeswere compared as effect indicators. The Q test was used for the heterogeneityanalysis. If there is homogeneity， the fixed effects model would be used; Ifheterogeneity, analysis the sources of heterogeneity, and use a random effectsmodel. If excessive heterogeneity across studies is not suitable forquantitative synthesis data in favor of the descriptive analysis. The funnelplot, fail-safe number, or Begg’s test were used to evaluate the publicationbias.Results:29studies were included, and the total patients were4681.The Meta analysis shows: the probability of CTC positive event in the group with CTC eventprobability maximum tumor diameter≤2cm group was significantly lower thanthe maximum tumor diameter>2cm group, the pooled odds ratio was0.652(Z=2.58, P=0.010) with95%CI (0.471,0.903). The events of CTCs and lymph nodestatus were not statistically related. The odds ratio was1.035(Z=0.18, P=0.859) with95%CI (0.710,1.508). The CTCs and the distant metastasis was notstatistically significant, the OR was1.162(Z=0.41, P=0.679) with95%CI(0.571,2.363). If the CTC was positive, the Disease-Free Survival was shorter,(HR=2.626, Z=9.34, P=0.000,95%CI [2.144,3.216]). The risk of death ofthe CTCs positive was as2.404times as the CTC-negative patients (HR=2.404,Z=6.67, P=0.000,95%CI [1.858,3.111]).Conclusion：Contrast with the CTC-negative patients, CTC-positive patientsis related with larger primary tumor size, shorter disease progression-free andoverall survival.