Predicative Factor Of Poor Prognosis Research Articles

The prognostic value of haematologic parameter changes during treatment in cervical cancer patients treated with definitive chemoradiotherapy

We retrospectively analysed the prognostic significance of changes in absolute neutrophil count (ANC), absolute lymphocyte count (ALC) and neutrophil/lymphocyte ratio (NLR) during treatment with definitive chemoradiotherapy (CRT) in 104 cervical cancer patients. The absolute white blood cell, ANC and ALC decrease during treatment, NLR increased throughout treatment and reached to a plateau at fifth week. The ANC and NLR after 3rd week of definitive CRT were significantly higher and ALC after 3rd week of treatment was significantly lower in patients with progressive disease compared patients with no evidence of disease. Patients in low-haematological risk (LHR) group had significantly higher number of patients with smaller tumour size, early stage disease and without lymph node metastasis. In multivariate analysis, high-haematological risk (HHR) group and lymph node metastasis were negative prognosticators of overall and disease-free survival (DFS). The presence of lymph node metastasis and HHR could serve as a predicative factor of poor prognosis for cervical cancer patients. IMPACT STATEMENT What is already known on this subject? The ANC and NLR after 3rd week of definitive CRT were significantly higher and ALC after 3rd week of treatment was significantly lower in patients with progressive disease compared patients with no evidence of disease. Patients in LHR group had significantly higher number of patients with smaller tumour size, early stage disease and without lymph node metastasis. Lymph node metastasis and HHR and were negative prognosticators of overall and disease-free survival (DFS). The presence of lymph node metastasis and HHR could serve as a predicative factor of poor prognosis for cervical cancer patients. What the results of this study add? Weekly changes in ANC, ALC, and NLR, especially after 3rd week of treatment are predictive factors of disease progression, not the high-risk features of disease. Furthermore, in HHR group more patients with extensive stage disease, larger tumour and lymph node metastasis were observed compared to LHR group. What the implications are of these findings for clinical practice and/or further research? The patients may be stratified according to risk factors. The treatment intensification maybe required for HHR patients compared to LHR patients. Since our findings are preliminary, further studies are required to support these findings.

Prognostic significance of neutrophil to lymphocyte ratio in ovarian cancer: evidence from 4,910 patients.

Increasing evidence indicates that elevated neutrophil to lymphocyte ratio (NLR) are related with poor prognosis in various types of tumors. However, the prognostic role of NLR in patients with ovarian cancer (OC) remains controversial. Thus, the current meta-analysis aimed to investigate the prognostic role of NLR in patients with OC. A total of 16 studies with 4,910 patients were included. By pooling hazard ratios (HRs) with 95% confidence intervals (CIs) and odds ratios (ORs) with 95% CIs from each study. The results demonstrated that elevated pretreatment NLR was significantly related to poor OS (HR: 1.50, 95% CI: 1.27-1.77) and PFS (HR: 1.53, 95% CI: 1.28-1.84) in patients with OC. Subgroup analyses was divided by ethnicity, sample size, histologic types, cut-off value of NLR, analysis method and NOS score, but the results did not showed any significant change the main results. This meta-analysis revealed that elevated pretreatment NLR might be a predicative factor of poor prognosis in OC patients.

E-cadherin expression as a prognostic factor in patients with ovarian cancer: a meta-analysis.

The prognostic role of epithelial cadherin (E-cadherin) downregulation in ovarian cancer has been assessed for years while the results remain inconclusive. The aim of our study was to assess this issue. Eligible studies were identified through searches of PubMed, EMBASE and Cochrane Database. In total, 1562 patients from 17 studies were included to assess the association between E-cadherin expression and overall survival/progression-free survival and clinicopathological characteristics of ovarian cancer patients. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (95% CI) were calculated to estimate the effect. The quality of 17 studies was evaluated using the Newcastle Ottawa Quality Assessment Scale. We also performed subgroup analysis, publication bias and sensitivity analysis in this meta-analysis. The results showed that negative E-cadherin expression significantly predicted poor overall survival of ovarian cancer patients (HR = 1.90, 95% CI = 1.50–2.40). However, negative E-cadherin was not associated with poor progression-free survival (HR = 1.19, 95% CI = 0.86–1.64). Moreover, Negative E-cadherin expression was distinctly associated with FIGO stage (OR = 0.42, 95% CI = 0.31–0.57), tumor grade (OR = 0.48, 95% CI = 0.34–0.67), metastasis (OR = 0.13, 95% CI = 0.07–0.26) and recurrence (OR = 0.48, 95% CI = 0.29–0.79). This meta-analysis revealed that negative E-cadherin expression might be a predicative factor of poor prognosis in ovarian cancer patients.

Prognostic significance of neutrophil-to-lymphocyte ratio in cervical cancer: A systematic review and meta-analysis of observational studies.

Background and aimsThe prognostic role of neutrophil-to-lymphocyte ratio (NLR) in cervical cancer are controversial. We conducted this meta-analysis to obtain a more accurate assessment of prognostic significance of NLR in cervical cancer.ResultsA total of 9 studies, consisting of 2,804 patients, were selected in this meta-analysis. Our pooled results showed that high pre-treatment NLR level was significantly associated with poorer overall survival (HR: 1.88, 95% CI 1.30–2.73) and shorter progression free survival (HR 1.65, 95% CI 1.18–2.29). Additionally, increased NLR was also significantly correlated with tumor size (OR 2.05, 95% CI 1.14–3.65), advanced FIGO stage (OR 2.12, 95% CI1.28–3.49) and lymph node involvement (OR 2.24, 95% CI 1.65–3.04).Materials and MethodsWe conducted a systematic literature search using the electronic databases PubMed, Web of Science, and Embase up to May 2016.Statistical analysis was performed using Stata 10.0.ConclusionsElevated pretreatment NLR could serve as a predicative factor of poor prognosis for cervical cancer patients.

Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Ovarian Cancer: A Systematic Review and Meta-Analysis of Observational Studies

Background and Aims: Published data on the prognostic role of neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer are controversial. We conducted this meta-analysis to obtain a more accurate assessment of prognostic significance of NLR in ovarian cancer. Materials and Methods: We conducted a systematic literature search using the electronic databases PubMed, Web of Science, and Embase up to May 2016. Hazard ratio (HR) and odd ratio (OR) with 95% confidence interval (95% CI) were calculated. Subgroup analyses were carried out to explore the source of heterogeneity. Statistical analysis was performed using Stata 10.0. Results: A total of 12 studies, consisting of 3,854 patients, which met our criterion were selected in this meta-analysis. Our pooled results showed that high pre-treatment NLR level was significantly associated with poorer overall survival (OS) (HR: 1.69, 95% CI 1.29-2.22) and shorter progression free survival (PFS) (HR 1.63, 95% CI 1.27–2.09). Additionally, increased NLR was also significantly correlated with advanced FIGO stage (OR 2.32, 95% CI1.79-3.00), higher serum level of CA-125 (OR 3.33, 95% CI 2.43-4.58), more extensive ascites (OR 3.54, 95% CI 2.31-5.42) as well as less chemotheraputic response (OR 0.53, 95% CI 0.40-0.70). The findings from most of subgroup meta-analyses were consistent with those from the overall meta-analyses. Conclusions: Elevated pre-treatment NLR could served as a predicative factor of poor prognosis for ovarian cancer patients.

Prognosis value of Hypoxia-inducible factor-1α expression in patients with bone and soft tissue sarcoma: a meta-analysis.

The prognostic significance of Hypoxia-inducible factor-1α (HIF-1α) in patients with bone and soft tissue sarcoma remains controversial. To investigate the impact of its expression on survival outcomes, we performed a meta-analysis. Comprehensive literature searches were conducted in PubMed, Web of Science, Embase and Cochrane Library. A total of 16 studies published from 2006 to 2015 were included. We found that expression of HIF-1α was significantly associated with higher rate of metastasis (RR 3.21, 95 % CI 2.12–4.84, P < 0.001), poorer overall survival (HR 2.05, 95 % CI 1.51–2.77, P < 0.001) and poorer disease-free survival (HR 2.05, 95 % CI 1.55–2.70, P < 0.001). In addition, when subgroup analysis was conducted according to histology type, the significant correlations to poor overall survival and disease-free survival were also observed in patients with osteosarcoma, chondrosarcoma and soft tissue sarcoma. Publication bias was not found and sensitivity analysis showed the results were stable. In conclusion, HIF-1α expression might be an effective predicative factor of poor prognosis for bone and soft tissue sarcoma.

Prognostic role of platelet to lymphocyte ratio in non-small cell lung cancers: A meta-analysis including 3,720 patients.

Platelet to lymphocyte ratio (PLR) was recently reported as a useful index in predicting the prognosis of lung cancer. However, the prognostic role of PLR in lung cancer remains controversial. The aim of this study was to evaluate the association between PLR and clinical outcome of lung cancer patients through a meta-analysis. Relevant literatures were retrieved from PubMed, Ovid, the Cochrane Library and Web of Science databases. Meta-analysis was performed using hazard ratio (HR) and 95% confidence intervals (CIs) as effect measures. A total of 5,314 patients from 13 studies were finally enrolled in the meta-analysis. The summary results showed that elevated PLR predicted poorer overall survival (OS) (HR: 1.526, 95%CI: 1.268-1.836, p < 0.001) in patients with lung cancer and OS (HR: 1.631, 95%CI: 1.447-1.837, p < 0.001) in patients with nonsmall cell lung cancer (NSCLC). Subgroup analysis revealed that increased PLR was also associated with poor OS in NSCLC treated by surgical resection (HR: 1.884, 95%CI: 1.308-2.714, P < 0.001) and non-surgery (HR: 1.570, 95%CI: 1.323-1.863, P < 0.001). In addition, PLR Cut-off value ≤ 160 (HR: 1.506, 95%CI: 1.292-1.756, P < 0.001) and PLR Cut-off value>160 (HR: 1.842, 95%CI: 1.523-2.228, P < 0.001). In contrast, elevated PLR was not associated with OS (HR: 1.117, 95%CI: 0.796-1.569, P > 0.05) in patients with small cell lung cancer (SCLC).This meta-analysis result suggested that elevated PLR might be a predicative factor of poor prognosis for NSCLC patients.

Prognostic significance of neutrophil-to-lymphocyte ratio in non-small cell lung cancer: a meta-analysis.

Published data on the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in non-small cell lung cancer (NSCLC) are controversial. We performed a meta-analysis to more accurately assess its prognostic value. The analysis was performed based on the data from 14 studies with 3,656 patients to estimate the correlation between NLR and overall survival (OS) and progression-free survival (PFS) in NSCLC. Hazard ratio (HR) with 95% confidence interval (CI) were calculated to estimate the effect. We also conducted subgroup analysis and meta-regression analysis. The results demonstrated that elevated pretreatment NLR predicted poorer OS (HR: 1.70, 95% CI: 1.39–2.09) and PFS (HR: 1.63, 95% CI: 1.27–2.09) in patients with NSCLC. Subgroup analysis indicated that cut-off value of 5 showed consistently prognostic value. There was no significant heterogeneity or publication bias for OS and PFS for included studies. This meta-analysis revealed that elevated pretreatment NLR might be a predicative factor of poor prognosis for NSCLC patients.

Prognostic significance of beta-catenin expression in patients with esophageal carcinoma: a meta-analysis.

Many studies have reported β-catenin involvement in the development of esophageal carcinoma (EC), but its prognostic significance for EC patients remains controversial. Therefore, we conducted this meta-analysis to explore the issue in detail. After searching PubMed, EMBASE, Web of Science, and Chinese Biomedical Literature Database, we included a total of ten relevant studies. We pooled the overall survival (OS) data using RevMan 5.2 software. The results showed that aberrant expression of β-catenin was associated with a significant increase of mortality risk (hazard ratio 1.71, 95%CI 1.46-2.01; p<0.00001). Subgroup analyses further suggested that aberrant expression of β-catenin resulted in poor OS of EC patients regardless of histological type of EC, study location or criteria for aberrant expression of β-catenin, and the sensitivity analyses revealed that the result was robust. The meta-analysis revealed that aberrant expression of β-catenin could be a predicative factor of poor prognosis for EC patients.

Prognosis value of HIF-1α expression in patients with non-small cell lung cancer

Hypoxia-inducible factor 1 (HIF-1) is a transcription factor that plays a critical role in the development and progression of tumors. Various studies evaluating the prognostic value of HIF-1α in patients with lung cancer (LC) remain controversial. To comprehensively and quantitatively summarize the evidence on the effect of HIF-1α expression on the survival of patients with LC, a meta-analysis was carried out. Electronic databases were used to identify published studies before August 31st, 2013. Studies were assessed for quality using REMARK. Data were collected comparing overall survival in patients with high HIF-1α expression with those with low expression. Totally, 13 papers including 1420 patients were subjected to final analysis. The combined hazard ratio (HR) was 1.60 (95% CI: 1.14-2.25, P=0.007), suggesting that high expression of HIF-1α was an indicator of poor prognosis. Further, when stratified by LC histological type (SCLC and NSCLC), study region (Asia and Europe), cut-off values (10%), tumor stage (I-III and I-IV), antibody for IHC (H1α67 and ESEE 122), and HR estimated method (univariate/multivariate analysis), most of the results were statistically significant. Taken together, this meta-analysis revealed that HIF-1α overexpression might be a predicative factor of poor prognosis for NSCLC particularly in Asia.

Poor Prognosis of Phosphatase of Regenerating Liver 3 Expression in Gastric Cancer: A Meta-Analysis

BackgroundOverexpression of phosphatase of regenerating liver 3 (PRL-3) has been implicated in gastric cancer (GC) metastasis. Epidemiological studies have evaluated the relationship between PRL-3 expression and prognosis in GC. However, results still remains controversial. In this study, a meta-analysis was performed to evaluate the association of PRL-3 expression with overall survival (OS) and clinicopathological characteristics.MethodsLiterature databases were searched to identify eligible studies dated until April 2013. Summary hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (95% CI) were calculated to estimate the association.ResultsA total of 1380 GC patients from six studies were included in the meta-analysis. Overall, the combined HR estimate for OS in a random-effect model was 1.89 (95% CI = 1.38–2.60; P<0.001). Results showed that PRL-3 overexpression was significantly associated with OS, indicating that it may be a biomarker for poor prognosis of GC. Both subgroup and sensitivity analyses further identified the prognostic role of PRL-3 expression in GC patients. Moreover, PRL-3 overexpression was significantly associated with tumor stage (OR = 2.25; 95% CI = 1.63–3.12; P<0.001), depth of invasion (OR = 2.03; 95% CI = 1.38–2.98; P<0.001), vascular invasion (OR = 2.52; 95% CI = 1.79–3.56; P<0.001), lymphatic invasion (OR = 3.74; 95% CI = 2.49–5.63; P<0.001), and lymph node metastasis (OR = 4.56; 95% CI = 2.37–8.76; P<0.001). However, when age, sex, tumor size, and tumor differentiation were considered, no obvious association was observed.ConclusionsThis meta-analysis reveals significant association of PRL-3 overexpression with OS and some clinicopathological features in GC. PRL-3 may be a predicative factor of poor prognosis and aggressive tumor behavior in GC patients.

Prognostic value of HIF-1α expression in patients with gastric cancer

The role of hypoxia-inducible factors-1 alpha (HIF-1α) expression in gastric cancer remains controversial. We performed a systematic review of the literature with meta-analysis. Electronic databases were used to identify published studies before December 1, 2012. Pooled hazard ratio (HR) or odds ratio (OR) with 95 % confidence interval (95 % CI) was used to estimate the strength of the association between HIF-1α expression and survival of gastric cancer patients. Heterogeneity and publication bias were also assessed. Final analysis of 1,268 patients from 9 eligible studies was performed. High HIF-1α expression was significantly correlated with poor overall survival (OS) of gastric cancer patients (HR = 2.14, 95 % CI = 1.32-3.48). Subgroup analysis indicated that HIF-1α over-expression had an unfavorable impact on OS in Asian patients (HR = 2.35, 95 % CI = 1.41-3.92). Moreover, up-regulation of HIF-1α was significantly associated with the depth of invasion (OR = 2.49, 95 % CI = 1.28-4.83), lymph node metastasis (OR = 2.15, 95 % CI = 1.27-3.66), and vascular invasion (OR = 2.23, 95 % CI = 1.20-4.14). HIF-1α expression might be a predicative factor of poor prognosis for gastric cancer particularly in Asia.

The prognostic value of E‐cadherin in gastric cancer: A meta‐analysis

The prognostic impact of E-cadherin downregulation in gastric cancer has been assessed for years while the results are controversial and heterogeneous. We thus comprehensively reviewed the evidence for evaluation of E-cadherin expression in gastric cancer to determine this effect. We searched PubMed and Embase to identify eligible studies, and 26 studies comprising 4,383 gastric cancer patients were included to assess the association between E-cadherin immunohistochemical expression and overall survival (OS) and clinicopathological characteristics. Summary hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (95% CI) were calculated to estimate the effect. We also performed meta-regression and subgroup analysis according to study location, publication year, number of patients, quality score of studies and cut-off value. Reduced E-cadherin expression was significantly correlated with poor OS of gastric cancer patients (HR 1.62, 95% CI 1.34-1.96). Subgroup analysis indicated that E-cadherin low-expression had an unfavorable impact on OS in Asian patients (HR 1.87, 95% CI 1.45-2.41). Moreover, downregulation of E-cadherin was significantly associated with TNM stage (OR 2.52, 95% CI 1.85-3.43), the depth of invasion (OR 2.01, 95% CI 1.39-2.90), lymph node metastasis (OR 2.39, 95% CI 1.68-3.40), distant metastasis (OR 2.23, 95% CI 1.21-4.11), grade of differentiation (OR 2.26, 95% CI 1.60-3.21), vascular invasion (OR 1.86, 95% CI 1.10-3.13) and histological type of gastric cancer (OR 4.22, 95% CI 2.96-6.02). This meta-analysis revealed that E-cadherin expression might be a predicative factor of poor prognosis for gastric cancer particularly in Asia.