Meta-analysis Shows That Detection of Circulating Tumor Cells Indicates Poor Prognosis in Patients With Colorectal Cancer

Rahbari, Nuh N.; Aigner, Maximilian; Thorlund, Kristian; Mollberg, Nathan; Motschall, Edith; Jensen, Katrin; Diener, Markus K.; Büchler, Markus W.; Koch, Moritz; Weitz, Jürgen

doi:10.1053/j.gastro.2010.01.008

« Previous Next »Gastroenterology
Volume 138, Issue 5 , Pages 1714-1726.e13, May 2010

Meta-analysis Shows That Detection of Circulating Tumor Cells Indicates Poor Prognosis in Patients With Colorectal Cancer

Nuh N. Rahbari
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
Maximilian Aigner
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
Kristian Thorlund
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
Nathan Mollberg
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
Edith Motschall
- Institute of Medical Biometry and Medical Informatics, University of Freiburg, Germany
Katrin Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
Markus K. Diener
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
Markus W. Büchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
Moritz Koch
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
Jürgen Weitz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
- Reprint requests Address requests for reprints to: Jürgen Weitz, MD, MSc, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120. fax: (49) 6221 56 5506

Received 25 April 2009; accepted 11 January 2010. published online 25 January 2010.

Background & Aims

The prognostic significance of circulating (CTCs) and disseminated tumor cells in patients with colorectal cancer (CRC) is controversial. We performed a meta-analysis of available studies to assess whether the detection of tumor cells in the blood and bone marrow (BM) of patients diagnosed with primary CRC can be used as a prognostic factor.

Methods

We searched the Medline, Biosis, Science Citation Index, and Embase databases and reference lists of relevant articles (including review articles) for studies that assessed the prognostic relevance of tumor cell detection in the peripheral blood (PB), mesenteric/portal blood (MPB), or BM of patients with CRC. Meta-analyses were performed using a random effects model, with hazard ratio (HR) and 95% confidence intervals (95% CIs) as effect measures.

Results

A total of 36 studies, including 3094 patients, were eligible for final analyses. Pooled analyses that combined all sampling sites (PB, MPB, and BM) associated the detection of tumor cells with poor recurrence-free survival (RFS) (HR = 3.24 [95% CI: 2.06–5.10], n = 26, I² = 77%) and overall survival (OS) (2.28 [1.55–3.38], n = 21, I² = 66%). Stratification by sampling site showed that detection of tumor cells in the PB compartment was a statistically significant prognostic factor (RFS: 3.06 [1.74–5.38], n = 19, I² = 78%; OS: 2.70 [1.74–4.20], n = 16, I² = 59%) but not in the MPB (RFS: 4.12 [1.01–16.83], n = 8, I² = 75%; OS: 4.80 [0.81–28.32], n = 5, I² = 82%) or in the BM (RFS: 2.17 [0.94–5.03], n = 4, I² = 78%; OS: 1.50 [0.52–4.32], n = 3, I² = 84%).