Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2023; 14(11): 504-517
Published online Nov 24, 2023. doi: 10.5306/wjco.v14.i11.504
Circulating tumor cells as potential prognostic biomarkers for early-stage pancreatic cancer: A systematic review and meta-analysis
Zi-Han Zhang, Yi-Wen Bao, Ya-Jun Zhao, Jian-Quan Wang, Jin-Tao Guo, Si-Yu Sun
Zi-Han Zhang, Yi-Wen Bao, Ya-Jun Zhao, Jian-Quan Wang, Jin-Tao Guo, Si-Yu Sun, Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Zhang ZH contributed to the data acquisition and analysis, and article drafting; Bao YW, Zhao YJ, and Wang JQ and Sun SY oversaw acquiring and analyzing data; Guo JT was the study supervisor and was responsible for the revision of the manuscript; all authors read and gave their final approval for this version of the manuscript to be submitted.
Supported by Liaoning Province Applied Basic Research Program Joint Program Project, No. 2022JH2/101500076; Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program, No. RC200438; Tree planting program of Shengjing Hospital, No. M1595.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Tao Guo, MD, PhD, Professor, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. guojt@sj-hospital.org
Received: June 28, 2023
Peer-review started: June 28, 2023
First decision: August 25, 2023
Revised: September 14, 2023
Accepted: October 26, 2023
Article in press: October 26, 2023
Published online: November 24, 2023
Processing time: 146 Days and 1.2 Hours
Abstract
BACKGROUND

Pancreatic cancer is difficult to be diagnosed early clinically, while often leads to poor prognosis. If optimal personalized treatment plan can be provided to pancreatic cancer patient at an earlier stage, this can greatly improve overall survival (OS). Circulating tumor cells (CTCs) are a collective term for various types of tumor cells present in the peripheral blood (PB), which are formed by detachment during the development of solid tumor lesions. Most CTCs undergo apoptosis or are phagocytosed after entering the PB, whereas a few can escape and anchor at distal sites to develop metastasis, increasing the risk of death for patients with malignant tumors.

AIM

To investigate the significance of CTCs in predicting the prognosis of early pancreatic cancer patients.

METHODS

The PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine, and ChinaInfo databases were searched for articles published through December 2022. Studies were considered qualified if they included patients with early pancreatic cancer, analyzed the prognostic value of CTCs, and were full papers reported in English or Chinese. Researches were selected and assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and the Newcastle-Ottawa Scale criteria. We used a funnel plot to assess publication bias.

RESULTS

From 1595 publications, we identified eight eligible studies that collectively enrolled 355 patients with pancreatic cancer. Among these original studies, two were carried out in China; three in the United States; and one each in Italy, Spain, and Norway. All eight studies analyzed the relevance between CTCs and the prognosis of patients with early-stage pancreatic cancer after surgery. A meta-analysis showed that the patients that were positive pre-treatment or post-treatment for CTCs were associated with decreased OS [hazard ratio (HR) = 1.93, 95% confidence interval (CI): 1.197-3.126, P = 0.007] and decreased relapse-free/disease-free/progression-free survival (HR = 1.27, 95%CI: 1.137-1.419, P < 0.001) in early-stage pancreatic cancer. Additionally, the results suggest no statistically noticeable publication bias for overall, disease-free, progression-free, and recurrence-free survival.

CONCLUSION

This pooled meta-analysis shows that CTCs, as biomarkers, can afford reliable prognostic information for patients with early-stage pancreatic cancer and help develop individualized treatment plans.

Keywords: Pancreatic cancer; Surgery; Prognosis; Systematic review; Meta-analysis; Biomarkers

Core Tip: There is no consensus regarding the prognostic value of circulating tumor cells (CTCs) in early-stage pancreatic cancer after surgery. This is the first systematic review and meta-analysis to investigate the potential of CTCs in predicting survival time in early pancreatic cancer. We pooled the analyses of the relationship between CTCs and overall/disease-free/progression-free/relapse-free survival in related studies. Patients testing positive for CTCs pre- or intra-surgery may have worse prognoses, requiring more intense chemotherapy and closer follow-up.