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目的:系统性评价骨髓中微转移肿瘤细胞(disseminating tumor cell,DTC)在乳腺癌患者预后预测中的作用。方法:检索Medline、Embase、中国数字化期刊全文数据库(CNKI)、万方数据库及维普全文网,收集DTC预测乳腺癌患者预后的研究,以无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)为观察终点,采用Review Manager 5.1.4进行Meta分析。结果:14篇英文文献包含4 091例乳腺癌患者纳入荟萃分析。结果提示DTC阳性组较阴性组在PFS[HR=1.83(95%CI:1.51～2.22),n=12,I2=75%]和OS[HR=1.59(95%CI:1.39～1.83),n=12,I2=58%]上均有统计学差异(P<0.000 01)。根据检测时间不同进行亚组分析,结果提示术前、术中和术后组DTC阳性的乳腺癌患者比DTC阴性者预后差;根据检测方法不同进行亚组分析,用免疫细胞化学(immunocytochemistry,ICC)或逆转录定量聚合酶链反应(reverse transcriptanse quantitative polymerasechain reaction,RT-qPCR)方法检测DTC阳性与其阴性者相比,预后差异均有统计学意义(P<0.000 01)。结论:术前、术中和术后DTC阳性的乳腺癌患者较DTC阴性者预后差。
Objective: To systematically evaluate the role of disseminating tumor cells (DTC) in the prognosis of patients with breast cancer. Methods: We searched Medline, Embase, CNKI, Wanfang database and VGP to collect prognosis of patients with breast cancer by DTC. Progression-free survival (PFS) and overall survival Overall survival (OS) was the end point of the review and Meta-analysis was performed using Review Manager 5.1.4. Results: Fourteen English articles containing 4 091 breast cancer patients were included in the meta-analysis. The results showed that the positive rates of OS in the DTC-positive group were significantly higher than those in the negative group (PFS [HR = 1.83 (95% CI: 1.51-2.22, n = 12,22,75%] and OS [HR = 1.59 = 12, I2 = 58%] were statistically significant (P <0.000 01). The subgroup analysis based on the different detection time suggested that the prognosis of DTC-positive breast cancer patients before, during and after surgery was worse than that of DTC negative patients. According to the different sub-groups, immunocytochemistry (ICC ) Or reverse transcriptanse quantitative polymerase chain reaction (RT-qPCR) method to detect DTC positive and negative patients, the prognosis difference was statistically significant (P <0.000 01). CONCLUSIONS: Preoperative, intraoperative, and postoperative DTC-positive breast cancer patients have a worse prognosis than DTC-negative patients.