| Objectives : To make a Meta—analysis of comparative studies concerning diagnosing hepatocelluar carcinoma via circulating tumor cells assay,in attemp to systemically evaluate the diagnostic value of CTCs assay for HCCMethods:By searching Pubmed,Web of Science,Cochrane Library and Embase etc,And hand searching relevant journals,We included articles published up to the beginning of July 2016,with no restriction on the start date.All studies are collected based on whether they exploying and evaluating CTCs assay's diagnostic value for HCC.Literature were screened according to inclusion and excluding criteria.Data were evaluated using STATA 12.0 for meta—analysis.The data included :(1)The pooled sensitivity and specificity of CTCs assay.(2)the sensitivity and specificity of subgroups.(3)the survival analysis.(4)Clinical correlationResults:20 studies involving 2256 patients metthe inclusion criteria,amongst998 subjects are subject to HCC group,while other 1258 subjects are assigned under control group.The pooled sensitivity and specificity of CTCs as a diagnostic tool for HCC in all of these studies was 0.67(95%CI: 0.55,0.78)and 0.98(95%CI: 0.94,1.00),respectively.,the overall PLR was 43.5(95%CI: 11.5,164.6),NLR was 0.33(95%CI:0.23,0.48).HCC diagnostic sensitivity in the subgroup of non-magneticactivated isolation was superior to that in the subgroup of magnetic-activated isolation(2=47.02,p<0.001),the NLR value in the subgroup of non-magneticactivated isolation was superior to that in the magnetic-activated isolation subgroup(NLR:0.18 vs.0.41;z=2.118,p=0.034).CTCs positivity was significantly associated with relapse-free survival [Hazard ratio(HR): 2.417,95%CI: 1.421-3.250;p<0.001],overall survival [HR:3.59,95%CI: 1.984-6.495;p<0.001].CTC positivity was associated with AFP?400ng/m L(Overall positive rate,56.61% vs.34.17%;RR,1.664;95% CI,1.117-2.478;p=0.012).When portal vein tumor thrombus(PVT)was present,the CTC positivity was greater(Overall positive rate,93.83% vs.44.32%;RR,2.059;95% CI,1.625-2.609;p<0.001).CTC positivity in TNM stage I and II wasless than that in stage III and IV(Overall positive rate,61.18% vs.89%;RR,0.614;95% CI,0.403-0.936;p=0.023),and was also associated with tumor size(Overall positive rate,49.82% vs.54.74%;RR,0.871;95% CI,0.765-0.992;p=0.038).Conclusion:The results of our meta-analysis suggest that the CTC assay could be used in HCC detection,because it has a high level of overall accuracy.However,independent application of this assay may produce a high probability error rate.Although the sensitivity of non-magnetic-activated isolation is superior to that of magnetic-activated isolation in CTC assays,we still have reservations regarding whether the ability for HCC diagnosis with the former isolation method is actually greater.the results will have a lower probability of error rate and will be more robust for a negative HCC diagnostic test when non-magnetic-activated isolation is used.Furthermore,use of CTC assay may allow evaluation of the poor clinicopathologic characteristics,and indicate a poor clinical prognosis for HCC patient... |
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