REMARK scoring of biomarkers predicting lymph node metastasis in oral squamous cell carcinoma – A systematic review

Abstract

Background: A universal and systematic protocol is essential for accurate reporting of biomarker studies. For unity in reporting biomarker studies, many guidelines were introduced, Recommendations for Tumor Marker Prognostic Studies (REMARK) being one of them. Aim: The purpose of this review is to evaluate the quality of published articles of biomarkers that predict metastasis in lymph nodes in oral squamous cell carcinoma (OSCC) by the use of the reporting recommendations for tumor marker prognostic (REMARK) guidelines. Methods: Comprehensive search was done in MEDLINE via PubMed and Cochrane from January 2015 to December 2019 to identify manuscripts evaluating biomarkers predicting lymph node metastasis in OSCC. The significance of the univariate and multivariate analysis was assessed for each manuscript, and P < 0.05 was considered statistically significant. Results: Thirty-six results were included for the qualitative synthesis. The mean REMARK score was 11.13 (range: 5.01–17.15). Biomarkers with the highest REMARK score were phospholipase C, cyclin D, CD44+/CD133+, and matrix metalloproteinase-9 (MMP-9). While biomarkers such as LGALS1, NCOA7, and TMOD1 were associated with high risk of bias, hence its use as a biomarker predicting lymph node metastasis is questionable. Conclusions: In our review of 36 manuscripts, manuscripts examining biomarkers evaluating lymph node metastasis in OSCC need an improvement in their reporting. Biomarkers such as phospholipase C, cyclin D, CD44+/CD133+, and MMP-9 can be used as a predictor of lymph node metastasis in OSCC.