本文選題：循環(huán)腫瘤細胞 + 結(jié)直腸癌��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的結(jié)直腸癌(colorectalcancer,CRC)是世界范圍內(nèi)最常見的發(fā)病率和死亡率較高的惡性腫瘤之一。部分研究表明循環(huán)腫瘤細胞(circulating tumor cells,CTCs)對結(jié)直腸癌具有預(yù)后價值,但還有部分研究表明其不存在預(yù)后價值,目前其預(yù)后價值存在爭議。此研究通過meta分析評估循環(huán)腫瘤細胞與結(jié)直腸癌患者預(yù)后的關(guān)系。方法通過檢索 PubMed,Medline 和 ISI Web of Science 數(shù)據(jù)庫(截至 2017 年 2 月),根據(jù)納入和排除標(biāo)準(zhǔn),有關(guān)循環(huán)腫瘤細胞與結(jié)直腸癌預(yù)后關(guān)系的文獻入選本研究。所有統(tǒng)計分析在Review Manager 5.3和STATA14.0軟件中完成。通過計算合并總生存期(overall survival,OS)和無進展生存期(progression free survival,PFS)的風(fēng)險比(hazard ratios,HRs)及相應(yīng)的 95%置信區(qū)間(confidence interval,CI),轉(zhuǎn)移相關(guān)的比值比(oddsratio,OR),治療反應(yīng)的危險比(riskratio,RR)等進行數(shù)據(jù)分析。結(jié)果本meta分析納入23個研究的6371例結(jié)直腸癌患者。與CTCs陰性患者相比,CTCs 陽性患者總生存期(OS:HR = 2.22,95%CI[1.76,2.82],P0.01,I2 = 58%)及無進展生存期(PFS:HR= 1.80,95%CI[1.52,2.14],P=0.04,I2 = 48%)均縮短,二者均具有統(tǒng)計學(xué)差異。在轉(zhuǎn)移陽性組CTCs的檢出率明顯高于轉(zhuǎn)移陰性組(OR =4.13,95%CI[1.78,9.57],P0.01,I2 = 0%)。有肝轉(zhuǎn)移的患者,CTCs 的檢出率明顯高于肝轉(zhuǎn)移陰性的患者(OR=2.72,95%CI[1.90,3.89],P0.01,I2 = 0%)。3 篇研究納入治療有效率的meta分析,CTCs陽性組的有效率與CTC陰性組無明顯差異(RR = 0.78,95%CI[0.78,1.02],P = 0.067,12 = 28.8%)。3 篇研究納入腫瘤控制率的meta分析,結(jié)直腸癌患者中CTCs陰性的患者相比于CTCs陽性的患者有更高的疾病控制率(RR = 0.89,95%CI[0.82,0.97],P = 0.008,12= 96.2%)。結(jié)論此meta分析預(yù)示著在結(jié)直腸癌患者外周血中CTCs有預(yù)后價值,CTCs陽性的結(jié)直腸癌比CTCs陰性的結(jié)直腸癌預(yù)后更差。此外,CTCs陰性預(yù)示著更高的疾病控制率,能夠為腫瘤影像學(xué)提供額外的預(yù)后信息,可能作為對化療反應(yīng)新的替代預(yù)測標(biāo)志物。
[Abstract]:Objective Colorectal cancer (CRC) is one of the most common malignant tumors with high morbidity and mortality worldwide. Some studies have shown that circulating tumor cells (circulating tumor cells have prognostic value for colorectal cancer, but others have shown that it does not have prognostic value, and its prognostic value is controversial at present. This study assessed the relationship between circulating tumor cells and prognosis of colorectal cancer patients by meta analysis. Methods by searching the PubMedline and ISI Web of Science databases (up to February 2017), the literature on the relationship between circulating tumor cells and the prognosis of colorectal cancer was included in this study according to the inclusion and exclusion criteria. All statistical analysis is performed in the Review Manager 5.3 and STATA14.0 software. The data were analyzed by calculating the hazard ratio (hazard / HRs), the corresponding 95% confidence interval (confidence / CI), the metastatic correlation ratio (oddsratioor) and the risk ratio of therapeutic response (RiskratioRR) for overall survival OS and (progression free survival without progression. Results the meta analysis included 6371 patients with colorectal cancer in 23 studies. Compared with CTCs negative patients, the total survival time (OS: HR = 2.22 / 95 CI [1.76 鹵2.82] P 0.01 I _ 2 = 58%) and the progressive survival time (PFS: HR= 1.80 ~ 95CI [1.52 鹵2.14] P 0.04I _ 2 = 48%) were significantly shorter than those in CTCs negative patients. The positive rate of CTCs in the metastatic positive group was significantly higher than that in the metastatic negative group (OR 4.1395 CI [1.789.57] P 0.01 I2 = 0%). The positive rate of CTCs in patients with liver metastasis was significantly higher than that in patients with negative hepatic metastasis (CI [1.90 鹵3.89] P0.01I _ 2 = 0%). 3 there was no significant difference in the effective rate between CTCs positive group and CTC-negative group (RR = 0.7895 CI [0.781.02] P = 0.067 7 12 = 28.8%). Meta analysis of tumor control rate, Patients with CTCs negative had a higher disease control rate than those with CTCs positive (RR = 0.89V 95 CI [0.82U 0.97] P = 0.00812 = 96.2%). Conclusion this meta analysis indicates that CTCs have prognostic value in peripheral blood of patients with colorectal cancer, and the prognosis of colorectal cancer with positive CTCs is worse than that with CTCs negative. In addition, CTCs negative predict higher disease control rate, which can provide additional prognostic information for tumor imaging, and may be used as a new alternative predictive marker for chemotherapy response.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34
，

本文編號：2058433