Abstract
B7 homolog 4 (B7-H4) has been recently reported to be a prognostic marker in non-small cell lung cancer (NSCLC) in some studies. However, the results remained conflicting. Thus, we aimed to comprehensively assess the association between B7-H4 expression and prognosis of NSCLC patients by performing a meta-analysis. Relevant publications were thoroughly searched of PubMed, Embase, Web of Science and China National Knowledge Infrastructure (CNKI). The pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were applied to evaluate the effects. A total of 9 studies comprising 1444 patients were included in this meta-analysis. B7-H4 overexpression was associated with presence of lymph node metastasis (OR=3.59, 95%CI=2.39-5.38, p<0.001; fixed effect), advanced TNM stage (OR=2.36, 95%CI=1.2-4.67, p=0.013; random effect), and poor differentiation (OR=2.11, 95%CI=1.12-3.99, p=0.021; fixed effect). However, B7-H4 had no significant correlation with gender, age or histology in NSCLC. Furthermore, in a fixed effects model, the results indicated that B7-H4 overexpression was significantly associated with poor OS (HR=2.03, 95%CI=1.41-2.92, p<0.001). This meta-analysis demonstrated that high B7-H4 expression is an unfavorable prognostic factor in NSCLC. Because few studies were included for meta-analysis and almost all included studies were performed on Chinese patients, therefore; large scale prospective studies are needed to verify our results.
Highlights
Lung cancer is the most commonly diagnosed cancer around the world [1]
The funnel plot was symmetrical and showed no evidence of publication bias (Begg’s p= 0.602). This is the first meta-analysis on the relationship between B7 homolog 4 (B7-H4) expression and clinicalpathological features and overall survival (OS) in non-small cell lung cancer (NSCLC) patients
By aggregating data from 9 studies with 1444 patients, we showed that elevated B7-H4 expression was significantly associated with presence of lymph node metastasis, advanced TNM stage, poor differentiation and shorter OS in NSCLC
Summary
Lung cancer is the most commonly diagnosed cancer around the world [1]. The prognosis of lung cancer is poor, and the overall 5 year survival is about 15% over the past decades [2]. Non-small cell lung cancer (NSCLC), accounting for approximately 80%-85% of all lung cancer cases, is the main form of lung cancer [3]. More than half of NSCLC patients are in advanced stages (stage IIIB/ IV) at first diagnosis, leading to a poor prognosis [2]. Despite several prognostic markers including performance status (PS), age and weight loss have been identified for prognostication. The predicative accuracy is still unsatisfactory [4]. More reliable prognostic markers are needed to make the management of NSCLC be more individualized
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