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Meta-Analysis
. 2018 Sep 7;13(9):e0203758.
doi: 10.1371/journal.pone.0203758. eCollection 2018.

Differential impact of circulating tumor cells on disease recurrence and survivals in patients with head and neck squamous cell carcinomas: An updated meta-analysis

Jae-Keun Cho  1 , Gil Joon Lee  2 , Hae-Dong Kim  1 , Uk Yeol Moon  3 , Min-Ji Kim  4 , Seonwoo Kim  4 , Kwan-Hyuck Baek  5 , Han-Sin Jeong  3
Affiliations
Meta-Analysis

Differential impact of circulating tumor cells on disease recurrence and survivals in patients with head and neck squamous cell carcinomas: An updated meta-analysis

Jae-Keun Cho et al. PLoS One. .

Abstract

Purpose: The prognostic impact of circulating tumor cells (CTC) on disease recurrence, progression and survivals in patients with head and neck squamous cell carcinoma (HNSCC) has not been adequately described. The objective of this study was to determine the impacts of the presence of CTC on loco-regional recurrence and survival of HNSCC patients by conducting a systematic review and meta-analysis.

Methods: A comprehensive search for articles published between 1990 and 2016 was conducted and data from these studies were extracted, using the MEDLINE, Cochrane Library, and EMBASE databases. The main outcomes were overall survival (OS) and recurrence-free survival (RFS) of HNSCC patients. Pooled hazard ratio (HR) and 95% confidence intervals (95%CI) were calculated using the random effect model for outcomes. The quality of the studies, heterogeneity and publication bias were assessed with the appropriate statistical methods.

Results: Six eligible studies with 429 patients were identified. The presence of CTC was significantly associated shorter RFS (HR = 4.88 [95%CI: 1.93-12.35], P < 0.001). However, it could not predict patients' OS (HR = 1.92 [95%CI: 0.93-3.96], P = 0.078). The following analyses using univariable values of each study also made the similar results (HR = 1.70 [95%CI: 0.83-3.45] for OS, HR = 3.79 [95%CI: 2.02-7.13] for RFS). Heterogeneity and publication bias were not significant, except one enrolled study.

Conclusions: The presence of CTC is not a significant prognostic indicator for OS of patients with HNSCC, although it could reflect the outcomes of loco-regional disease.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of study selection process.
CTC: circulating tumor cells, HNSCC: head and neck squamous cell carcinoma.
Fig 2
Fig 2. Forest plots illustrating prognostic value of CTC detection on the overall and recurrence-free survivals in HNSCC patients.
HR: hazard ratio, 95%CI: 95% confidence interval.
Fig 3
Fig 3. Funnel plots of analyzed studies according to the overall and recurrence-free survivals.
SE: standard error, HR: hazard ratio.
See this image and copyright information in PMC

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