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Predictive value of circulating cell-free DNA in the survival of breast cancer patients: A systemic review and meta-analysis.

ABSTRACT: PURPOSE:Circulating cell-free DNA (cfDNA) has been reported to predict outcomes in patients with various types of cancer. However, its prognostic value in patients with breast cancer is not well established still now. In this meta-analysis, we evaluated the prognostic role of cfDNA in breast cancer patients. METHODS:We performed systematic searches in electronic databases to identify studies that evaluated the prognostic value of cfDNA in breast cancer patients. The end points were progression-free survival (PFS) and overall survival (OS). The hazard ratios (HRs) and their 95% confidence intervals (95% CIs) were extracted to assess the prognostic significance of cfDNA. Subgroup analyses were also conducted. RESULTS:A total of 11 publications involving 1467 patients were included in this meta-analysis. cfDNA was shown to be significantly associated with PFS (HR 2.02, 95% CI 1.51-2.72, P?

SUBMITTER: Yang J

PROVIDER: S-EPMC6076113 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Predictive value of circulating cell-free DNA in the survival of breast cancer patients: A systemic review and meta-analysis.

Yang Jing J Cheng Li L Zhang Jing J Chen Linyan L Wang Denian D Guo Xinli X Ma Xuelei X

Medicine 20180701 28

<h4>Purpose</h4>Circulating cell-free DNA (cfDNA) has been reported to predict outcomes in patients with various types of cancer. However, its prognostic value in patients with breast cancer is not well established still now. In this meta-analysis, we evaluated the prognostic role of cfDNA in breast cancer patients.<h4>Methods</h4>We performed systematic searches in electronic databases to identify studies that evaluated the prognostic value of cfDNA in breast cancer patients. The end points wer ...[more]

PMID: 29995790

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Project description:ImportanceFragmented DNA is continuously released into the circulation following apoptosis and necrosis of both cancerous and noncancerous cells; when it is released by cancer cells, it is specifically known as circulating tumor DNA (ctDNA). Previous studies have suggested that ctDNA can reflect tumor burden and guide potential therapeutic targets.ObjectiveTo determine the association of ctDNA with breast cancer disease-free survival (DFS) and progression-free survival in early, locally advanced, and metastatic breast cancer.Data sourcesAn electronic search was conducted using the Cochrane Library, ScienceDirect, PubMed, and Embase from July 30, 2019, to October 31, 2019; all languages were included. The following search terms were used: ctDNA OR circulating tumor DNA OR liquid biopsy AND breast cancer OR breast carcinoma OR breast tumor AND prognosis OR survival. All titles were screened, and the appropriate abstracts were reviewed. If any data were missing, the authors contacted the study authors for permission to access data and extrapolate hazard ratios (HRs).Study selectionTo be included in the analysis, the studies had to meet the following prespecified inclusion criteria: (1) a ctDNA blood sample was measured; (2) DFS, progression-free survival, or relapse-free survival was reported as an HR; and (3) the patient population only had breast cancer. Retrospective and prospective observational cohort studies were included.Data extraction and synthesisTwo authors (C.C. and C.F.) independently reviewed the literature. All data were recorded independently by both authors and were compared at the end of the reviewing process to limit selection bias. Duplicates were removed and any disparities were clarified. Data were pooled using a fixed-effects or random-effects model according to the study heterogeneity. This study adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE).Main outcomes and measuresThe primary outcome was the association of ctDNA with DFS or relapse-free survival in breast cancer. Secondary outcomes focused on subgroup analysis in the setting of early breast cancer and metastatic breast cancer.ResultsFrom a total of 263 publications found using the predefined search terms, data from 8 studies (3.0%) reporting on 739 patients in total were suitable for inclusion. Circulating tumor DNA gene variation detection (both before and after treatment) was statistically significantly associated with shorter DFS (HR, 4.44; 95% CI, 2.29-8.61; P < .001). Detection of ctDNA was statistically significantly associated with a reduction in DFS in both the early breast cancer subgroup (HR, 8.32; 95% CI, 3.01-22.99; P < .001) and the metastatic or locally advanced subgroup (HR, 1.91; 95% CI, 1.35-2.71; P < .001). Pretreatment and posttreatment plasma sample collection was analyzed in both early and metastatic groups. The posttreatment group encompassed both surgical and oncologic therapy. Pretreatment plasma detection of ctDNA was statistically significantly associated with reduced DFS (HR, 3.30; 95% CI, 1.98-5.52; P < .001). Posttreatment sampling of ctDNA failed to achieve statistical significance (HR, 8.17; 95% CI, 1.01-65.89; P = .05).Conclusions and relevanceIn this systematic review and meta-analysis, elevated plasma ctDNA was associated with a high risk of relapse. This finding suggests that plasma ctDNA may provide an excellent method to stratify risk and personalize patient follow-up.

Dataset Information

Predictive value of circulating cell-free DNA in the survival of breast cancer patients: A systemic review and meta-analysis.

Publications

Predictive value of circulating cell-free DNA in the survival of breast cancer patients: A systemic review and meta-analysis.

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