<p>The diagnostic value of circulating tumor cells and ctDNA for gene mutations in lung cancer</p>

Abstract

Purpose: Detecting gene mutations by two competing biomarkers, circulating tumor cells (CTCs) and ctDNA has gradually paved a new diagnostic avenue for personalized medicine. We performed a comprehensive analysis to compare the diagnostic value of CTCs and ctDNA for gene mutations in lung cancer. Methods: Publications were electronically searched in PubMed, Embase, and Web of Science as of July 2018. Pooled sensitivity, specificity, and AUC, each with a 95% CI, were yielded. Subgroup analyses and sensitivity analyses were conducted. Quality assessment of included studies was also performed. Results: From 4,283 candidate articles, we identified 47 articles with a total of 7,244 patients for qualitative review and meta-analysis. When detecting EGFR , the CTC and ctDNA groups had pooled sensitivity of 75.4% (95% CI 0.683–0.817) and 67.1% (95% CI 0.647–0.695), respectively. When testing KRAS , pooled sensitivity was 38.7% (95% CI 0.266–0.519) in the CTC group and 65.1% (95% CI 0.558–0.736) in the ctDNA group. The diagnostic performance of ctDNA in testing ALK and BRAF was also evaluated. Heterogeneity among the 47 articles was acceptable. Conclusion: ctDNA might be a more promising biomarker with equivalent performance to CTCs when detecting EGFR and its detailed subtypes, and superior diagnostic capacity when testing KRAS and ALK . In addition, the diagnostic performance of ctDNA and CTCs depends on the detection methods greatly, and this warrants further studies to explore more sensitive methods. Keywords: lung cancer, circulating tumor cell, circulating tumor DNA, gene mutations