目的 探讨ctDNA在食管恶性肿瘤预后评估中的临床应用价值。方法 使用Pubmed、Cochrane Library、Embase和Web of Science数据库,检索文章中探讨ctDNA在食管恶性肿瘤预后评估中的临床应用价值,检索时间从建库至2022-11-24。由两名研究者分别独立检索数据库,筛查文献后对数据进行提取、分析,并分析纳入文献的偏倚风险,提取无病生存期(PFS)和总生存期(OS)的风险比(HR),使用Revman 5.3进行统计分析,采用卡方检验计算合并结果之间的异质性。结果 本研究包含321例患者临床资料,其中ctDNA预测食管恶性肿瘤的PFS Meta分析共纳入了8项研究,食管恶性肿瘤患者的无进展生存期(PFS)异质性较低(I2=28%,P>0.05),因此采用固定效应模型计算(HR=4.14,95% CI:2.65~6.47,P<0.05),ctDNA阳性患者与较差的PFS相关;在ctDNA预测食管恶性肿瘤患者总生存期(OS)的荟萃分析中,共纳入了4项研究,异质性较低(I2=15%,P>0.05),采用固定效应模型,ctDNA阳性患者的OS较ctDNA阴性患者预后差(HR=4.71,95% CI: 2.78~7.97,P<0.05)。结论 ctDNA检测有望成为食管恶性肿瘤患者预后的辅助检查手段。
Abstract
Objective To explore the clinical application value of circulating tumor DNA (ctDNA) in prognostic evaluation of esophageal malignancies. Methods Pubmed, Cochrane Library, Embase and Web of Science databases were used to search articles discussing the clinical application value of ctDNA in the prognosis assessment of esophageal malignancies from the establishment of the database to November 24, 2022. Two researchers independently searched the database, screened the literature, extracted and analyzed the data, analyzed the risk of bias in the included literature, extracted the risk ratio (hr) of disease-free survival (DFS) and overall survival (OS), and used Revman 5.3 for statistical analysis. Chi-square test was used to calculate the heterogeneity among the combined results. Results A total of 321 patients were included in this study, among which 8 studies were included in the PFS meta-analysis of ctDNA prediction of esophageal malignancies. he heterogeneity of progression-free survival (PFS) in patients with esophageal malignancies was low (I2=28%, P>0.05), so the fixed-effect model was used (HR=4.14, 95%CI :2.65~6.47, P<0.05). The results showed that ctDNA-positive patients were associated with poor PFS. In the meta-analysis of ctDNA’s prediction of overall survival (OS) in patients with esophageal malignancies, a total of 4 studies were included, with low heterogeneity(I2=15%, P>0.05). Using a fixed-effect model, CtDNA-positive patients had worse prognosis than ctDNA-negative patients with OS(HR=4.71, 95%CI: 2.78~7.97, P<0.05). Conclusions Tumor-associated ctDNA detection is expected to become an auxiliary prognostic measure for patients with esophageal malignancies.
关键词
食管恶性肿瘤 /
ctDNA /
Meta分析
Key words
esophageal malignancy /
ctDNA /
Meta-analysis
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参考文献
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