Abstract：
Renal cell carcinoma (RCC) is a type of tumor with high morbidity and recurrence rates. The application of circulating tumor cells (CTCs) in RCC remains controversial. Hence, we performed a meta-analysis to elucidate the diagnostic and prognostic value of CTCs in RCC. To obtain a precise conclusion, a systematic search was conducted in Pubmed, Cochrane Database, Embase and Web of Science up to Dec 01, 2022. We also further identified the references in relevant studies. The diagnostic accuracy variables (sensitivity, specificity) and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to access precise of CTCs and relationship between CTCs and disease stages, respectively. Heterogeneity test, sensitivity analysis, meta-regression and publishing bias were also applied. A total of 12 studies involving 767 patients were considered to be included in the final meta-analysis. The results revealed that the overall sensitivity, specificity of CTC detection in RCC were 45% (95%CI, 32-60%) and 99% (95%CI, 97-100%), respectively. In subgroup analysis, diagnostic sensitivity of CTCs in clear cell renal cell carcinoma (ccRCC) (69%, 95%CI; 50-88%) was significantly higher than other RCC subtypes (34%, 95%CI; 21-48%) (p<0.05). Meanwhile, advanced diseases (stage III-IV) were more likely to find CTCs than localized diseases (stage I-II) (OR, 2.29; 95%CI, 1.37-3.83; p = 0.002). This systematic review and meta-analysis demonstrated that CTC detection could be considered as a promising auxiliary diagnostic and staging method for RCC, especially ccRCC subtype. Meanwhile, the presence of cytokeratin-positive CTCs is highly likely associated with increased risk of poor prognosis in RCC.
摘要：
肾细胞癌（RCC）是一种发病率和复发率都很高的肿瘤。循环肿瘤细胞（CTCs）在肾癌中的应用仍存在争议。因此，我们进行了一项荟萃分析,以阐明CTC在RCC中的诊断和预后价值.为了得到一个准确的结论，在Pubmed进行了系统的搜索，Cochrane数据库,Embase和WebofScience至2022年12月1日。我们还进一步确定了相关研究中的参考文献。诊断准确性变量(灵敏度，特异性）和比值比（ORs）以及相应的95％置信区间（CIs）用于获取CTC的准确性以及CTC与疾病分期之间的关系，分别。异质性检验，敏感性分析，还应用了元回归和发表偏差。共有12项研究涉及767名患者被认为包括在最终的荟萃分析中。结果表明，总体灵敏度，肾癌中CTC检测的特异性分别为45%(95CI,32-60%)和99%(95CI,97-100%),分别。在亚组分析中，CTC在透明细胞肾细胞癌（ccRCC）中的诊断敏感性（69％，95CI；50-88%）显著高于其他RCC亚型（34%，95CI；21-48%）（p<0.05）。同时,晚期疾病（III-IV期）比局部疾病（I-II期）更容易发现CTC（OR，2.29；95CI，1.37-3.83；p=0.002）。这项系统评价和荟萃分析表明，CTC检测可以被认为是RCC的一种有前途的辅助诊断和分期方法。尤其是ccRCC亚型。同时,细胞角蛋白阳性CTC的存在很可能与RCC不良预后风险增加相关.
