Abstract
Background Many studies have shown the link between the pretreatment serum transthyretin and prognosis in gastrointestinal (GI) cancers. However, based on the conclusion, the initial findings were inconsistent. Hence, this meta-analysis was performed to identify the prognostic values of the pretreatment serum transthyretin in GI cancers. Methods Previous studies published before November 2018 were collected from a comprehensive literature search of several databases. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were applied in the assessment of the intensity of associations. Also, the publication bias and the robustness of merged data were assessed. All statistical analyses were undertaken using STATA/SE 14.1. Results The combined data indicated that the pretreatment serum transthyretin level was related to the prognosis in GI cancers. The group with reduced pretreatment transthyretin had a significantly worse overall survival (OS) (HR = 1.71, 95% CI: 1.37-2.05). The subgroup analysis for OS further showed the predictive value of transthyretin. In addition, the low serum transthyretin level could be an unfavorable factor for recurrence-free survival (RFS) or progression-free survival (PFS) (HR = 1.66, 95% CI: 1.14-2.18) in GI cancers. Conclusion The low pretreatment serum transthyretin level implies an unfavorable prognosis for patients with GI cancers. The monitoring of pretreatment transthyretin level could contribute to the risk stratification and individualized therapy in GI cancers.
Highlights
Transthyretin, known as prealbumin, is mainly synthesized by the hepatocyte and less likely caused by hepatic disease compared to other serum proteins [1, 2]
An essential prognostic significance of transthyretin was highlighted in intrahepatic cholangiocarcinoma (ICC) (HR = 1 76, 95% confidence intervals (CIs): 1.02–2.51) in the random effects model (P = 0 090; I2 = 65 1%), adenocarcinoma of the esophagogastric junction (AEG) (HR = 2 26, 95% CI: 1.60–2.91) in the fixed effects model (P = 0 683; I2 = 0 0%), and hepatocellular carcinoma (HCC) (HR = 1 48, 95% CI: 1.25– 1.71) in the fixed effects model (P = 0 301; I2 = 18 0%), but not in gastric cancer (GC) (HR = 1 10, 95% CI: 0.89–1.31) in the fixed effects model (P = 0 268; s)
A vital correlation was shown between the low transthyretin level and shorter overall survival (OS) for GI tract cancers (HR = 1 92, 95% CI: 1.11-2.73) and non-GI tract cancers (HR = 1 62, 95% CI: 1.29-1.96)
Summary
Transthyretin, known as prealbumin, is mainly synthesized by the hepatocyte and less likely caused by hepatic disease compared to other serum proteins [1, 2]. The prognostic significance of pretreatment transthyretin in patients with digestive cancer is inconsistent [11,12,13,14]. Some studies suggested that pretreatment transthyretin is significantly linked to the prognosis of patients with gastrointestinal (GI) cancers, but some have failed to get similar results. Many studies have shown the link between the pretreatment serum transthyretin and prognosis in gastrointestinal (GI) cancers. Based on the conclusion, the initial findings were inconsistent This meta-analysis was performed to identify the prognostic values of the pretreatment serum transthyretin in GI cancers. The combined data indicated that the pretreatment serum transthyretin level was related to the prognosis in GI cancers. The low pretreatment serum transthyretin level implies an unfavorable prognosis for patients with GI cancers. The monitoring of pretreatment transthyretin level could contribute to the risk stratification and individualized therapy in GI cancers
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