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. 2017 Jun 16;8(35):59527-59538.
doi: 10.18632/oncotarget.18521. eCollection 2017 Aug 29.

The prognostic and diagnostic value of circulating tumor cells in bladder cancer and upper tract urothelial carcinoma: a meta-analysis of 30 published studies

Zheng Zhang  1 , Wei Fan  1   2 , Qiaoling Deng  1 , Shihui Tang  1 , Ping Wang  1 , Peipei Xu  1 , June Wang  1 , Mingxia Yu  1
Affiliations

The prognostic and diagnostic value of circulating tumor cells in bladder cancer and upper tract urothelial carcinoma: a meta-analysis of 30 published studies

Zheng Zhang et al. Oncotarget. .

Abstract

There are inconsistent conclusions in the association between circulating tumor cells (CTCs) and urothelial cancer (UC). We performed a meta-analysis to assess the prognostic and diagnostic value of CTCs in UC. We search Medline, Embase and Web of science for relevant studies. The study was set up according to the inclusion/exclusion criteria. 30 published studies with a total of 2161 urothelial cancer patients were included. Meta-analysis showed that CTC-positive was significantly associated with tumor stage (≤ II vs III, IV) (OR = 4.60, 95% CI: 2.34-9.03), histological grade (I, II vs III) (OR = 2.91, 95% CI: 1.92-4.40), metastasis (OR = 5.12, 95% CI: 3.47-7.55) and regional lymph node metastasis (OR = 2.47, 95% CI: 1.75-3.49). It was also significantly associated with poor overall survival (OS) (HR = 3.98, 95% CI: 2.20-7.21), progression/disease-free survival (PFS/DFS) (HR = 2.22, 95% CI: 1.80-2.73) and cancer-specific survival (CSS) (HR = 5.18, 95% CI: 2.21-12.13). Overall sensitivity and specificity of CTC detection assays were 0.35 (95% CI: 0.28-0.43) and 0.97 (95% CI: 0.92-0.99) respectively. In summary, our meta-analysis suggests that the presence of CTCs in the peripheral blood is an independent predictive indicator of poor outcomes for urothelial cancer patients. It can also be used as a noninvasive method for the confirmation of cancer diagnosis. More studies are required to further explore the role of this marker in clinical practice.

Keywords: bladder cancer; circulating tumor cells (CTCs); meta-analysis; prognosis; urothelial cancer.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. PRISMA flowchart of the selection process
Figure 2
Figure 2
Forest plots of association between the presence of CTCs and (A) TNM staging, (B) histological grade, (C) disease metastasis, (D) regional lymph node metastasis.
Figure 3
Figure 3. Sensitivity analysis of the studies
(A) TNM stage, (B) histological grade, (C) disease metastasis, (D) regional lymph node metastasis.
Figure 4
Figure 4. Meta-analysis of HRs for the association of the presence of CTCs with CSS, OS and DFS/PFS
Figure 5
Figure 5. Forest plot showing study-specific (right-axis) and mean sensitivity and specificity with corresponding heterogeneity statistics
Figure 6
Figure 6. Summary ROC curve with confidence and prediction regions around mean operating sensitivity and specificity point
Figure 7
Figure 7. Deeks’ funnel plot with regression line
See this image and copyright information in PMC

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