Abstract
BACKGROUND: In order to find new biomarkers related to gastric cancer diagnosis, in recent years, some researchers have confirmed that circulating tumor cells (CTCs) can be used in the diagnosis of gastric cancer, but the results are inconsistent among studies. In this study, we used meta-analysis to systematically evaluate the diagnostic value of CTCs for gastric cancer. METHODS: A comprehensive search was carried out using the following databases: PubMed, Embase, Cochrane Library, Web of Science, Ovid MEDLINE, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu Chinese database, Chinese Biomedical Literature (CBM) database, and Duxiu database. The aim of this extensive search was to find published studies that investigated the role of CTCs in the diagnosis of gastric cancer, especially in patients with both gastric and non-gastric cancer. The search spanned from the inception of each database to January 30, 2025. Subsequently, eligible studies underwent a stringent screening process. They were evaluated according to a set of pre-determined literature inclusion and exclusion criteria. The quality of the included literature was appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) scale, a tool developed to assess the quality of studies in the area of cancer research. Relevant data were then extracted, and a meta-analysis of the included studies was conducted using MetaDiSc 1.4 and Stata 16.0 software. RESULTS: A total of 18 papers were included in this study, encompassing 1,399 gastric cancer patients and 750 non-gastric cancer controls. Meta-analysis indicated that the heterogeneity of the included papers was due to a non-threshold effect. Meta-regression analysis revealed that the identification of the test method might be the main source of heterogeneity. The random-effects model analysis showed that the combined sensitivity of the cell-based CTC test for diagnosing gastric cancer was 0.78 [95% confidence interval (CI): 0.76-0.80], the combined specificity was 0.93 (95% CI: 0.91-0.94), the combined positive likelihood ratio (PLR) was 9.13 (95% CI: 6.36-13.12), the combined negative likelihood ratio (NLR) was 0.24 (95% CI: 0.18-0.33), and the diagnostic odds ratio (DOR) was 43.83 (95% CI: 27.12-70.84). The area under the summary receiver operating characteristic (sROC) curve (AUC) was 0.9274, and the Q* value was 0.8621. Regarding sensitivity analyses, the results of this study were relatively stable, and the diagnostic test Deeks funnel plot demonstrated that there was no publication bias in this study. CONCLUSIONS: CTCs have relatively high sensitivity, specificity and accuracy in the diagnosis of gastric cancer patients, which has certain value for the clinical diagnosis of gastric cancer.