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Ju M, Gao Z, Gu G, Huang H, Sun A, Zheng C, Li H, Zhang Y, Li K. Prognostic value of circulating tumor cells associated with white blood cells in solid cancer: a systematic review and meta-analysis of 1471 patients with solid tumors. BMC Cancer 2023; 23:1224. [PMID: 38087278 PMCID: PMC10717563 DOI: 10.1186/s12885-023-11711-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The clinical relevance of circulating tumor cell-white blood cell (CTC-WBC) clusters in cancer prognosis is a subject of ongoing debate. This study aims to unravel their contentious predictive value for patient outcomes. METHODS We conducted a comprehensive literature search of PubMed, Embase, and Cochrane Library up to December 2022. Eligible studies that reported survival outcomes and examined the presence of CTC-WBC clusters in solid tumor patients were included. Hazard ratios (HR) were pooled to assess the association between CTC-WBC clusters and overall survival (OS), as well as progression-free survival (PFS)/disease-free survival (DFS)/metastasis-free survival (MFS)/recurrence-free survival (RFS). Subgroup analyses were performed based on sampling time, treatment method, detection method, detection system, and cancer type. RESULTS A total of 1471 patients from 10 studies were included in this meta-analysis. The presence of CTC-WBCs was assessed as a prognostic factor for overall survival and PFS/DFS/MFS/RFS. The pooled analysis demonstrated that the presence of CTC-WBC clusters was significantly associated with worse OS (HR = 2.44, 95% CI: 1.74-3.40, P < 0.001) and PFS/DFS/MFS/RFS (HR = 1.83, 95% CI: 1.49-2.24, P < 0.001). Subgroup analyses based on sampling time, treatment method, detection method, detection system, cancer type, and study type consistently supported these findings. Further analyses indicated that CTC-WBC clusters were associated with larger tumor size (OR = 2.65, 95% CI: 1.58-4.44, P < 0.001) and higher alpha-fetoprotein levels (OR = 2.52, 95% CI: 1.50-4.22, P < 0.001) in hepatocellular carcinoma. However, no significant association was found between CTC-WBC clusters and TNM stage, depth of tumor invasion, or lymph node metastasis in the overall analysis. CONCLUSIONS CTC-WBC clusters are negative predictors for OS and PFS/DFS/MFS/RFS in patients with solid tumors. Monitoring CTC-WBC levels may provide valuable information for predicting disease progression and guiding treatment decisions.
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Affiliation(s)
- Mingguang Ju
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China
| | - Ziming Gao
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China
| | - Gaoxiang Gu
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China
| | - Haibo Huang
- VIP International Department, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China
| | - Anqi Sun
- VIP International Department, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China
| | - Chen Zheng
- Department of Anesthesiology, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China
| | - He Li
- Department of Ultrasound, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China
| | - Yixiao Zhang
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China
| | - Kai Li
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Heping District, The First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Shenyang City, 110001, China.
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