Meta-analysis of the association between CTCs and survival outcomes in urothelial carcinoma

To systematically evaluate the correlations between the characteristics of circulating tumor cells (CTCs) and survival outcomes in patients with urothelial carcinoma (UC) receiving first-line chemotherapy. A comprehensive search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases to collect relevant English observational studies (cohort studies or case-control studies) focusing on patients with UC receiving first-line chemotherapy and investigating the associations between CTC characteristics and survival outcomes (progression-free survival [PFS], overall survival [OS]), published from the establishment of the databases to August 2025. Two researchers independently screened the literature based on predefined inclusion and exclusion criteria, extracted the data, and evaluated the quality using the Newcastle-Ottawa Scale (NOS). The main combined indicator was the hazard ratio (HR) and its 95% confidence interval (CI). Statistical analysis was performed using RevMan 5.3 software. The I² statistic was used to assess heterogeneity, and Egger’s test and sensitivity analysis were used to evaluate publication bias and the stability of the results. A total of 6 studies involving 577 patients with urothelial carcinoma were finally included. The results of the Meta-analysis showed that patients with high-risk CTC characteristics (CTC positivity, high CTC count, or expression of specific molecular markers) had a significantly higher risk of disease progression (HR = 2.84, 95% CI [1.66, 4.83], Z = 3.83, P < 0.001). They also had a significantly higher risk of death (HR = 3.05, 95% CI [1.74, 5.32], Z = 3.91, P < 0.001). High-risk CTC characteristics are strong predictors of poor survival outcomes in UC. CTC-based liquid biopsy holds promise for risk stratification, especially in metastatic patients, and should be integrated into future prospective trials to validate its utility in guiding individualized therapy.