title: Meta-analysis shows that circulating tumor cells including circulating microRNAs are useful to predict the survival of patients with gastric cancer.
abstract: BACKGROUND
  Circulating tumor cells (CTCs) are metastatic cells disseminated into the bloodstreams. They have been proposed to monitor disease progression for decades. However, the prognostic value of CTCs in gastric cancer (GC) remains controversial. We performed a meta-analysis to investigate the topic.
  
  
  METHODS
  A systematic search was made for relevant studies in academic data bases, involving the Medline, Embase, and Science Citation Index. Data on prognosis of GC patients, such as recurrence-free survival (RFS) and overall survival (OS), were extracted when possible. The meta-analysis was performed with the random effects model and the pooled hazard ratios (HRs) and their associated 95% confident intervals (95%CIs) were computed as effect measures.
  
  
  RESULTS
  Twenty six studies (including 40 subgroups) with peripheral blood samples of 1950 cases from 10 countries were included in the final analysis. The pooled results showed that GC patients with detectable CTCs (including circulating miRNAs) had a tendency to experience shortened RFS (HR=2.91, 95% CI [1.84-4.61], I2=52.18%, n=10). As for patient deaths, we found a similar association of CTC (including circulating miRNAs) presence with worse OS (HR=1.78, 95% CI [1.49-2.12], I2=30.71%, n=30). Additionally, subgroup analyses indicated strong prognostic powers of CTCs, irrespective of geographical, methodological, detection time and sample size differences of the studies.
  
  
  CONCLUSIONS
  Our meta-analysis shows that CTCs (including circulating miRNAs) can predict the survival of GC patients. Large prospective studies are warranted to determine the best sampling time points, detection methods in homogeneous patients with GC in the future.
authors.forename: Zhen-yu
authors.initials: ZY
authors.lastname: Zhang
authors.forename: Zhen-ling
authors.initials: ZL
authors.lastname: Dai
authors.forename: Xiao-wei
authors.initials: XW
authors.lastname: Yin
authors.forename: Shu-heng
authors.initials: SH
authors.lastname: Li
authors.forename: Shu-ping
authors.initials: SP
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Pudong New District, No, 150, Jimo Road, Shanghai 200120, China. gesurgery@163.com.
authors.forename: Hai-yan
authors.initials: HY
authors.lastname: Ge
mesh_terms: D006801:Humans; D035683:MicroRNAs / Q000097:blood / Q000235:genetics*; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D017594:Publication Bias; D013274:Stomach Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology*
chemical_list: D035683:MicroRNAs