title: Prognostic value of circulating tumor cells in esophageal cancer.
abstract: OBJECTIVE
  To perform a meta-analysis of the related studies to assess whether circulating tumor cells (CTCs) can be used as a prognostic marker of esophageal cancer.
  
  
  METHODS
  PubMed, Embase, Cochrane Library and references in relevant studies were searched to assess the prognostic relevance of CTCs in patients with esophageal cancer. The primary outcome assessed was overall survival (OS). The meta-analysis was performed using the random effects model, with hazard ratio (HR), risk ratio (RR) and 95% confidence intervals (95%CIs) as effect measures.
  
  
  RESULTS
  Nine eligible studies were included involving a total of 911 esophageal cancer patients. Overall analyses revealed that CTCs-positivity predicted disease progression (HR = 2.77, 95%CI: 1.75-4.40,P< 0.0001) and reduced OS (HR = 2.67, 95%CI: 1.99-3.58,P< 0.00001). Further subgroup analyses demonstrated that CTCs-positive patients also had poor OS in different subsets. Moreover, CTCs-positivity was also significantly associated with TNM stage (RR = 1.48, 95%CI: 1.07-2.06,P= 0.02) and T stage (RR = 1.44, 95%CI: 1.13-1.84,P= 0.003) in esophageal cancer.
  
  
  CONCLUSIONS
  Detection of CTCs at baseline indicates poor prognosis in patients with esophageal cancer. However, this finding relies on data from observational studies and is potentially subject to selection bias. Prospective trials are warranted.
authors.affiliation: Hai-Tao Xu, Jian-Wei Liu, Lian-Guo Zhang, Qing-Guang Zhang, Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China.
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Xu
authors.affiliation: Hai-Tao Xu, Jian-Wei Liu, Lian-Guo Zhang, Qing-Guang Zhang, Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Miao
authors.affiliation: Hai-Tao Xu, Jian-Wei Liu, Lian-Guo Zhang, Qing-Guang Zhang, Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Liu
authors.affiliation: Hai-Tao Xu, Jian-Wei Liu, Lian-Guo Zhang, Qing-Guang Zhang, Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China.
authors.forename: Lian-Guo
authors.initials: LG
authors.lastname: Zhang
authors.affiliation: Hai-Tao Xu, Jian-Wei Liu, Lian-Guo Zhang, Qing-Guang Zhang, Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China.
authors.forename: Qing-Guang
authors.initials: QG
authors.lastname: Zhang
mesh_terms: D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D009362:Neoplasm Metastasis; D009360:Neoplastic Cells, Circulating; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome
keywords: Circulating tumor cells; Esophageal cancer; Meta-analysis; Prognosis