| Background and Objective Pancreatic caner is the worst prognostic tumors.Prognostic indicators including CA19-9 and CEA have very limited sensitivity and specificity.In recent years,some clinical researchers have proved that circulating tumor cells in peripheral blood have a prognostic value for patients with pancreatic cancer,while some others differ from that.So we performed a meta-analysis to evaluate the prognostic role of CTCs in patients with pancreatic cancer.Method A systematic literature search of PubMed,Cochrane,BMJ,,Web of science,Ovid,Web of science,Wanfang,CNKI and Vip was conducted from the building of the database to February 2017.Medical subject headings terms included "pancreatic cancer"?"circulating tumor cells"?"prognostic"?"survival".Studies were included if they met the following criteria:(1)Randomized controlled studies or cohort studies utilizing peripheral blood to predict the prognosis of patients with pancreatic cancer;(2)All patients were conformed to the diagnosis of pancreatic cancer through histopathological examination;(3)Detection methods were described in detail in all studies;(4)Providing complete prognostic data such as overall survival(OS),progress free survival(PFS);(5)Supplying sufficient information to calculate the hazard risk(HR)and 95%CI.Literature were written in Chinese or English.If the same patients were included in two studies by one person,the study with more data or published recently was included.The software STATA 12.0 was used in this analysis.Results A total of 12 studies selected from 267 studies with 755 confirmed individuals were included according to the inclusion exclusion criteria.The results of meta-analysis showed that:(1)Patients in CTC-positive group showed shorter OS than those in CTC-negative group.(HR=0.25,95%CI=0.17-0.33,P<0.001),and the same result was also drawn in terms of PFS(HR =0.39,95%CI=0.13-0.65,P=0.003);(2)Sub-group analysis by race indicated that CTC-positive patients had shorter OS than CTC-negative patients in both Asian and occidental populations(Asian-group:HR=0.58,95%CI=0.42-0.74,P<0.001,Occidental-group:HR=0.15,95%CI=0.06-0.23,P=0.001);(3)Sub-group analysis by detection methods indicated that CTC-positive patients showed shorter OS than CTC-negative patients in Cellsearch,Immunomagnetic beads and RT-PCR groups(P1<0.001,P3=0.005,P4<0.001),and as for PFS that could be also seen in Cellsearch,Immunomagnetic beads and RT-PCR groups(P1=0.003,P2=0.013,P3<0.001);(4)Sub-group analysis by treatment methods indicated that CTC-positive patients showed shorter OS than CTC-negative patients in surgery,chemotherapy and combined groups(P1=0.008,P2<0.001,P3=0.012);(5)Sub-group analysis by TNM stages indicated that CTC-positive patients showed shorter OS than CTC-negative patients in ? +?/?+?<1 and>1 groups(P1?P2<0.001),and as for PFS that could be also seen in those two groups(P1=0.005,P2<0.001);(6)Sub-group analysis by lymph nodes metastasis indicated that CTC-positive patients showed both shorter OS than CTC-negative patients in>0.5 groups(P1=0.017).Conclusion Our meta-analysis indicated CTC-positive patients had both worse OS and PFS than CTC-negative patients,hence detection of CTCs in peripheral blood has essential prognostic value for patients with pancreatic cancer. |
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