| Background:The recurrence and metastasis rate of CRC patients who suffer from postoperative is still very high,and there are still some patients who suffer from postoperative will die of recurrence and metastasis.The current clinical early diagnosis of CRC is colonoscopy,biopsy,etc.,and the detection methods for recurrence and metastasis after CRC are tumor markers and imaging examinations such as CT.This type of examination lacks high sensitivity and specificity for recurrence and metastasis after CRC.Some studies believe that circulating tumor cells(CTCs)in the peripheral blood,as a tumor marker,can be used as an indicator of recurrence and metastasis after CRC.Objective:To systematically evaluate the diagnostic value of CTCs in postoperative recurrence and metastasis of CRC,it can provide diagnostic basis for clinical prevention and treatment of recurrence and metastasis of CRC.The relationship between CTCs and postoperative symptoms and signs of CRC patients was analyzed to provide certain clinical basis for clinical monitoring of disease progression of patients and TCM prevention and treatment of postoperative recurrence and metastasis of CRC patients.Methods:In the first part,the Cochrane systematic evaluation method was used to search the original CTCs and CRC literatures published by PubMed,Cochrane Library,Embase,Chinese Biomedical Literature Database(CBM),Chinese Science and Technology Journals Full Text Database(CNKI)and Wanfang Database from their establishment to November 30,2020 by computer.The quality of the studies was assessed using the Quadas2 scale(developed by the Cochrane Collabation),and the included studies were quantitatively and systematically evaluated using Meta-Disc 1.4 and Statal5.0 software.Two graduate students independently searched relevant literature and extracted relevant data,and calculated the Sensitive(Sen),Specificity(Spe),Positive Likelihood Ratio(+LR),Negative Likelihood Ratio(-LR),Diagnostic Odds Ratio(DOR)and Summary Receiver Operating Characteristics(SROC)curve of CTCs in the diagnosis of postoperative recurrence and metastasis of CRC.Selection in the second part studies,Selected 32 patients with CRC who were treated at the outpatient clinic of Xiyuan Hospital of the Chinese Academy of Chinese Medical Sciences in December 2018 and January 2021 with high-risk stage II and stage III radical surgery and within 3 months of chemotherapy,and perform CTC detection.The relationship between signs and symptoms of 32 patients and CTC number were analyzed by SPSS25.0 statistical software.Result:1.A total of 14 articles meeting the inclusion criteria were included in the first part of the study,including 1749 cases in total.The quality of the literature was generally high.After aggregating the indicators,the Sen and Spe of peripheral blood CCTs in the diagnosis of postoperative recurrence and metastasis of CRC were 0.71[95%CI(0.67,0.75)],0.80[95%CI(0.78,0.82)],+LR 3.61[95%CI(2.25,5.80)],-LR 0.38[95%CI(0.27,0.54)],DOR 10.66[95%CI(5.26,21.62)],and area under the SROC curve AUC was 0.829.Q value is 0.7617,prior probability is 20%,posterior probability is 48%.2.In the second part of the study:(1)There were 19 males of the 32 patients included in this study,accounting for 59.4%;13 were females,accounting for 40.6%,and there were more men than women,the ratio was about 1.46:1.In the distribution of CTC counts,there are 3 cases of males with 0 CTC,7 cases with 1 CTC,7 cases with 2 CTCs,and 2 cases with CTC>2;The distribution of women with 0,1,2,and more than 2 CTCs were 3,3,4,and 3 cases respectively;there was no statistical difference in the CTC count between the two distributions(P=0.671).(2)There is an oldest patient who is 75 years old and a youngest patient who is 34 years old,the average age is 58.34±9.01 years,the largest proportion of each age group is more than 60 years old,accounting for 50%;the least 50 years old and below,accounting for 18%in terms of age distribution;The distribution of 0,1,2,and 2 CTCs for 50 years and younger is 0,1,2 and 3 respectively;for those aged 50-60 is 2 cases,4 cases,4 cases,and 0 case;The above are 4 cases,5 cases,5 cases and 2 cases respectively for those aged 60 years old;there is no statistical significance in the distribution of CTC counts in each age group(P=0.063).(3)In terms of tumor stage,4 cases of stage II patients,accounting for 12.5%,28 cases of stage III patients,accounting for 87.5%;in stage II patients,CTC counts of 0 and 1 accounted for 2 cases.The distribution of CTC counts in stage Ⅲ patients is 4 cases with 0 CTC,8 cases with 1 CTC,11 cases with 2 CTCs,and 5 cases with more than 2 CTCs;there is no relationship between CTC counts and staging Statistical significance(P=1.00).(4)In terms of tumor location,16 of the 32 patients included had tumors located in the colon,there were 14 patients located in the rectum,one patient was located at the junction between the straight and the second,and there was still one located in the rectum and ascending colon.3 cases had no CTC detected,5 cases had 1 CTC detected,6 cases had 2 CTCs,and 2 cases had more than 2 CTCs among the patients whose tumor was located in the colon.In patients with tumors located in the rectum,3 cases,4 cases,5 cases and 2 cases were detected with 0,1,2,and 2 CTCs respectively.In addition,2 patients whose tumors were located at the junction of ectum and sigmoid colon and rectum and ascending colon were detected with 1 CTC and more than 2 CTCs,respectively.There was no statistical difference in CTC counts at the tumor location(P=0.856).(5)The distribution of symptoms,the most common symptoms and signs were fatigue(24 cases),pale red tongue and thin white fur(20 cases),loss of appetite(17 cases),diarrhea(13 cases),abdominal distension(12 cases),and soreness of the waist and the knees(12 cases).11 cases),greasy tongue coating(6 cases),purplish red tongue with ecchymosis(5 cases),etc.,accounting for 75%,62.5%,53.1%,40.6%,37.5%,34.4%,18.8%,15.6%,respectively.Fatigue accounted for the highest proportion in the group with 2 CTCs,81.2%;pale red tongue and thin white coating accounted for the highest proportion in the group with 0 CTCs,83.3%;loss of appetite,diarrhea,abdominal distension,waist-Knee soreness,purple tongue with ecchymosis,and greasy tongue coating are in the group with CTC of 0,CTC greater than 2,one group with CTC 1,one group with CTC 2,one group with CTC greater than 2,and CTC greater than Group 2 has the highest proportion,accounting for 66.7%,60%,50%,45.5%,40%and 40%respectively.In addition,it was found that all patients with purple tongue and ecchymosis were found in patients with CTC>0.Statistical analysis found that the relationship between symptoms and signs and the number of CTCs in each group was not statistically significant;between each group with 0,1,2,more than 2 CTCs and in the distribution of symptoms and signs there was no statistical difference(P=0.591).Conclusion:1.Peripheral blood circulating tumor cells have high diagnostic value for recurrence and metastasis of colorectal cancer after surgery.2.The diagnostic value of CTCs in stage Ⅳ postoperative CRC is maybe higher.3.CTCs detected one week after CRC may be more correlated with recurrence and metastasis.4.The longer the follow-up time is,the more correlated CTCs is with postoperative recurrence and metastasis of CRC.5.The most common symptoms of patients after CRC are fatigue,diarrhea,abdominal distension,soreness of waist and knees,pale red tongue,thin white coating,purple tongue,petechiae,greasy tongue coating,etc.6.In the distribution of symptoms and signs which include fatigue,diarrhea,abdominal distension,soreness and weakness of waist and knees,pink tongue,thin white tongue,purple tongue,ecchymosis,and greasy tongue after postoperative chemotherapy among patients with different CTC counts,there was no statistical significance.7.Purplish red tongue and petechiae appear in patients with CTC>0,perhaps it suggests that the existence of CTC is related to blood stasis syndrome. |
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