| Objective:In order to promote the earlier diagnosis and treatment of hepatocellular carcinoma(HCC),and to discover a more specific and sensitive serum biomarker.Here we aim to evaluate the clinical values of circulating tumor cell(CTC)in the diagnosis and prognosis of HCC.Methods:The literatures were searched extensively through a broad range of databases,including Pubmed,Embase,Cochrane Library,Web of Science,CNKI and WanFang Database,selected CTCs diagnostic studies that CTCs isolated from peripheral blood and can provide required data.The QUADAS and QUADAS-2 quality evaluation tables were applied to evaluate literatures.A total of 25 literatures involving 1813 patients were included in this meta-analysis,including 1156 cases in the HCC group and 657 cases in the control group.The statistical analysis were performed using the stata12.0 software,to analyze the overall accuracy of diagnosis and the survival index analysis.Results:CTC as a diagnostic marker for HCC,the pooled sensitivity of was 0.66(95%Cl:0.58~0.74)and the specificity was 0.98(95%Cl:0.96~0.99);The overall PLR was 37.6(95%Cl:15.0~94.5),and the overall NLR was 0.34(95%Cl:0.27~0.44);The diagnostic odds ratio was 110(95%Cl:41~294),overall AUC was 0.93(95%Cl:0.91~0.95)according to our meta-analysis.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic ratio were superior in the immunostaining identification group than PCR identification group,they were 0.73 vs 0.63,1.00 vs 0.95,256.5 vs 13.8,0.27 vs 0.39,and 955 vs 35,respectively.The AUC was 0.98 in immunostaining identification group compared to the 0.91 in PCR identification group.There was no significant difference between magnetic and non-magnetic separation methods.Hazard Ratio(HR)is the ratio of the risk ratio between the experimental group and the control group.CTCs positivity was significantly associated with the overall survival rate(OS),HR=1.94(95%Cl1.32~2.84),and relapse free survival(RFS)was 2.55(95%CI:1.40~4.64).The positive CTCs were negatively correlated with the OS and RFS,indicating that CTC-positive patients had a shorter OS and RFS than CTCs negative patients.In addition,CTC showed positive correlation with AFP in the diagnosis of HCC.The sensitivity and specificity of CTC in HCC patients were all higher than AFP,indicating that serum CTC detection is benefit for the earlier diagnosis of HCC.Conclusions:CTC appears can be used as a biomarker for the diagnosis of HCC.However,more clinical trials are needed to further evaluate the sensitivity of CTCs for its diagnostic efficacy.The sensitivity,specificity and diagnostic ratio of immunostaining identification group are better than that of PCR identification group.Therefore,the immunostaining identification has higher diagnostic value for HCC with the same isolation method.The sensitivity and specificity of CTC to the HCC were also higher than AFP,suggesting that CTC can be used for the earlier diagnosis of HCC,and also can be used to predict the recurrence,metastasis and prognosis of HCC patients because of its significant correlation between OS and relapse free survival. |
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