Abstract
Lymph node metastasis commonly occurs in gastric cancer. Previous studies have demonstrated that the overexpression of lymphatic microvessel density (LVD) is correlated with various malignancies. To evaluate the potential role of LVD in various malignancies, we conducted a systematic review and meta-analysis to thoroughly investigate the association of LVD expression with tumor progression and survival in gastric cancer. We performed a comprehensive search of common databases and selected studies demonstrating the relationship between LVD expression and gastric cancer prognosis. Hazard ratios (HR) were used to determine the value of LVD for predicting gastric cancer metastasis and prognosis. The data were extracted from the included studies and pooled with the appropriate effects model using STATA 12.0. The results showed that high LVD expression obviously impacted the prognosis of gastric cancer, based on an overall survival (OS) HR of 2.58 (95% CI: 1.91–3.48, P < 0.001) and a disease-free survival (DFS) HR of 2.51 (95% CI: 1.35–4.68, P = 0.004) in the univariate analysis. In addition, the results of the multivariate analysis indicated a remarkable relationship between high LVD expression and gastric neoplasm prognosis. The pooled OS HR was 4.12 (95% CI: 3.45–4.91, P < 0.001). The current meta-analysis shows that high LVD is closely related to tumor metastasis and poor prognosis in gastric malignancy. LVD could be a key factor in tumor lymphatic metastasis. Moreover, LVD is likely a potential index and an effective biomarker for the prediction of patient prognosis.
Highlights
Cancer is currently the second most common cause of death in the United States, and it is expected to surpass heart disease as the leading cause of death in the coming years [1]
The results showed that high lymphatic microvessel density (LVD) expression obviously impacted the prognosis of gastric cancer, based on an overall survival (OS) Hazard ratios (HR) of 2.58 and a disease-free survival (DFS) HR of 2.51 in the univariate analysis
Two studies were ineligible for evaluation in this meta-analysis as they did not provide sufficient data to estimate HRs and variances, and we tried to contact the authors, there was no response
Summary
Cancer is currently the second most common cause of death in the United States, and it is expected to surpass heart disease as the leading cause of death in the coming years [1]. Half of all patients diagnosed with gastric cancer show advanced disease and a poor 5-year survival rate of less than 20% [3, 4]. Based on these statistics, the high death rate of cancer has attracted public attention to the diagnosis and treatment of this disease, and it is of paramount importance to identify factors that can efficiently predict survival and response to treatment to help select better therapeutic tools from among the available resources [3]. The molecules of tumor cells or stroma cells can stimulate lymphatic vessel formation, thereby facilitating tumor cell invasion. This process of lymphangiogenesis occurs prior to metastasis, creating a favorable microenvironment for disseminating primary tumor cells [5]. The discovery and application of antibody markers of lymphatic endothelial cells make lymphangiogenesis and tumor metastasis easier to assess
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