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Meta-Analysis
. 2018 Mar;97(13):e0197.
doi: 10.1097/MD.0000000000010197.

The prognostic value of circulating cell-free DNA in breast cancer: A meta-analysis

Guoqiang Tan  1 , Chang Chu, Xiujuan Gui, Jinyuan Li, Qiufang Chen
Affiliations
Meta-Analysis

The prognostic value of circulating cell-free DNA in breast cancer: A meta-analysis

Guoqiang Tan et al. Medicine (Baltimore). 2018 Mar.

Abstract

Background: Circulating cell-free DNA (cfDNA) isolated from plasma or serum by noninvasive procedures can serve as a "liquid biopsy" and has potential as a biomarker for the tumor burden and survival prediction of breast cancer (BC). However, its prognostic value in patients with BC is currently under debate. The aim of this meta-analysis was to investigate the relationship between cfDNA and survival outcome.

Methods: We systematically searched PubMed, Embase, and Science Citation Index electronic databases for studies about the prognostic utility of cfDNA in patients with BC. The clinical characteristics, relapse/disease-free survival (RFS/DFS), and overall survival (OS) data were extracted from the eligible studies. The hazard ratios (HR) and 95% confidence intervals (CI) were calculated and pooled with a fixed-effects model using the Stata12.0 software. Subgroup and sensitivity analyses were also performed.

Results: This meta-analysis included a total of 10 eligible studies and 1127 patients with BC. The pooled HR with 95% CI showed strong associations between cfDNA and OS (HR = 2.41, 95% CI, 1.83-3.16) along with DFS/RFS (HR = 2.73, 95% CI, 2.04-3.67) in patients with BC. Although publication bias was found in the studies regarding RFS/DFS, further trim and fill analysis revealed that the adjusted HR would be 2.53 (95% CI, 1.83-3.51), which is close to the original HR. Subgroup analyses confirmed the role of cfDNA as a strong prognostic marker in patients with BC, regardless of cfDNA analysis, sampling time, sample source, detection method, tumor stage, sample size, or area.

Conclusions: Our meta-analysis indicates that cfDNA is a strong predictive and prognostic marker in patients with BC.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart of studies selection.
Figure 2
Figure 2
Forest plot of hazard ratios for correlations between cfDNA analysis and OS.
Figure 3
Figure 3
Forest plot of hazard ratios for correlations between cfDNA analysis and RFS/DFS.
Figure 4
Figure 4
Funnel plots of publication bias for OS (A) and RFS/DFS (B) in present meta-analysis.
Figure 5
Figure 5
Funnel plots of trim and fill analysis for RFS/DFS in present meta-analysis.
Figure 6
Figure 6
Cumulative meta-analyses of OS by publication year.
Figure 7
Figure 7
Cumulative meta-analyses of RFS/DFS by publication year.
See this image and copyright information in PMC

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