Background
Methods
Literatures research
Criteria for literature selection
Data extraction and quality assessment
Statistic analysis
Results
Summary of systemic literature search
1st author (Ref.) | Year | Country | Cancer site | Sample size | Study duration | Study design | AAPR cutoff value | High | Low | Treatment strategy | Survival outcome | HR (95%CI) | Source (Via analysis) | Follow-up (months) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Li H [10] Training | 2020 | China | HCC | 149 | 2003–2014 | R | 0.38 by ROC | 72 | 77 | LT | OS | 1.98 (1.28–3.08) | Crude (U) | More than 60 |
OS | 1.71 (1.06–2.71) | Crude (M) | ||||||||||||
DFS | 1.11 (0.69–1.76) | Estimated by Curve (U) | ||||||||||||
Li H [10] Validation | 2020 | China | HCC | 61 | 2003–2014 | R | 0.38 by ROC | 26 | 35 | LT | OS | 2.72 (1.29–5.75) | Estimated by Curve (U) | More than 60 |
DFS | 1.80 (0.88–3.70) | Estimated by Curve (U) | ||||||||||||
Zeng X [11] | 2020 | China | NPC | 255 | 2014–2018 | R | 0.63 by ROC | 101 | 154 | Multiple modalities | OS | 1.57 (0.67–3.72) | Crude (U) | Median 33.5 (2.1–151.2) |
DFS | 1.98 (0.94–4.14) | Crude (U) | ||||||||||||
Zhou S [12] | 2020 | China | SCLC | 224 | 2009–2018 | R | 0.35 (NR) | 171 | 53 | Chemotherapy | OS | 1.55 (1.07–2.25) | Crude (U) | Up to 90 |
OS | 1.65 (1.11–2.46) | Crude (M) | ||||||||||||
Li Q [13] | 2020 | China | HCC | 188 | 2010–2015 | R | 0.40 by X-tile | 94 | 94 | Curative resection | OS | 1.80 (1.30–2.52) | Estimated by Data (U) | Median 46.5 |
DFS | 1.57 (1.21–2.04) | Estimated by Data (U) | ||||||||||||
Zhang C [14] | 2019 | China | CC | 230 | 2008–2014 | R | 0.68 by ROC | 89 | 141 | Curative resection | OS | 2.97 (1.23–7.19) | Crude (U) | Median 80 (12–137) |
OS | 3.02 (1.24–7.41) | Crude (M) | ||||||||||||
DFS | 2.49 (1.15–5.41) | Crude (U) | ||||||||||||
DFS | 2.58 (1.17–5.68) | Crude (M) | ||||||||||||
Xia A [15] Training | 2019 | China | RCC | 419 | 2004–2014 | R | 0.39 by ROC | 365 | 54 | Curative resection | OS | 3.00 (1.62–5.57) | Estimated by Data (U) | Median 50.0 (30.4–83) |
OS | 2.75 (1.27–5.95) | Crude (M) | ||||||||||||
CSS | 2.43 (1.20–4.93) | Estimated by Data (U) | ||||||||||||
CSS | 3.04 (1.28–7.24) | Crude (M) | ||||||||||||
Xia A [15] Validation | 2019 | China | RCC | 204 | 2004–2014 | R | 0.39 by ROC | 179 | 25 | Curative resection | OS | 4.77 (2.16–10.52) | Estimated by Data (U) | Median 50.2 (29.8–83.1) |
CSS | 4.48 (1.59–12.61) | Estimated by Data (U) | ||||||||||||
Li SJ [16] | 2019 | China | LC | 390 | 2013–2015 | P | 0.57 by ROC | 178 | 212 | Curative resection | OS | 4.76 (2.56–8.33) | Crude (U) | Median 50.0 (12–66) |
OS | 3.23 (1.67–6.25) | Crude (M) | ||||||||||||
DFS | 2.17 (1.43–3.33) | Crude (U) | ||||||||||||
DFS | 1.67 (1.06–2.63) | Crude (M) | ||||||||||||
Xiong JP [17] | 2019 | China | CCA | 303 | 2002–2014 | R | 0.41 by ROC | 253 | 50 | Multiple modalities | OS | 3.56 (1.28–9.92) | Crude (U) | Median 21 |
OS | 2.88 (1.19–5.78) | Crude (M) | ||||||||||||
DFS | 2.52 (1.38–4.75) | Crude (U) | ||||||||||||
DFS | 2.31 (1.40–3.29) | Crude (M) | ||||||||||||
Zhang L [18] | 2019 | China | NSCLC | 496 | 2006–2010 | R | 0.64 by ROC | 199 | 297 | Curative resection | OS | 2.15 (1.64–2.82) | Crude (U) | Median 47 (2–96) |
OS | 1.87 (1.22–2.74) | Crude (M) | ||||||||||||
DFS | 2.18 (1.66–2.85) | Crude (U) | ||||||||||||
DFS | 1.96 (1.30–2.96) | Crude (M) | ||||||||||||
Li D [19] | 2019 | China | NSCLC | 290 | 2007–2013 | R | 0.36 by ROC | 201 | 89 | Multiple modalities | OS | 1.70 (1.32–2.20) | Crude (U) | Median 16 (1–84) |
OS | 1.53 (1.17–1.98) | Crude (M) | ||||||||||||
Li X [20] | 2019 | China | SCLC | 122 | 2013–2015 | R | 0.61 by ROC | 37 | 85 | Chemoradiotherapy | OS | 1.69 (1.02–2.78) | Crude (U) | Up to 70 |
PFS | 1.61 (1.01–2.50) | Crude (U) | ||||||||||||
Long ZQ [21] | 2019 | China | BC | 746 | 2011–2013 | R | 0.525 by ROC | 621 | 125 | Curative resection | OS | 2.78 (1.45–5.23) | Crude (U) | More than 60 |
OS | 2.24 (1.02–4.88) | Crude (M) | ||||||||||||
Kim JS [22] | 2019 | Korea | NPC | 100 | 1998–2016 | R | 0.487 by ROC | 80 | 20 | Chemoradiotherapy | OS | 1.77 (0.74–4.24) | Crude (M) | Median 50.6 |
PFS | 1.40 (0.63–3.10) | Crude (M) | ||||||||||||
Tan P [23] | 2018 | China | UTUCs | 692 | 2003–2016 | R | 0.58 by ROC | 249 | 443 | Curative resection | OS | 1.82 (1.37–2.42) | Crude (U) | Median 42 |
OS | 1.59 (1.19–2.13) | Crude (M) | ||||||||||||
DFS | 1.55 (1.20–2.00) | Crude (U) | ||||||||||||
DFS | 1.34 (1.03–1.74) | Crude (M) | ||||||||||||
CSS | 2.03 (1.46–2.80) | Crude (U) | ||||||||||||
CSS | 1.75 (1.25–2.44) | Crude (M) | ||||||||||||
Chen ZH [24] Training | 2018 | China | HCC | 372 | 2009–2013 | R | 0.439 by ROC | 117 | 255 | TACE | OS | 1.26 (1.04–1.55) | Estimated by Curve (U) | More than 60 |
OS | 1.57 (1.16–2.12) | Crude (M) | ||||||||||||
Chen ZH [24] Validation 1 | 2018 | China | HCC | 202 | 2009–2013 | R | 0.439 by ROC | NR | NR | Supportive care | OS | 2.14 (1.17–3.90) | Crude (M) | More than 60 |
Chen ZH [24] Validation 2 | 2018 | China | HCC | 82 | 2013–2014 | R | 0.439 by ROC | NR | NR | TACE | OS | 2.87 (1.25–6.29) | Crude (M) | More than 60 |
Pu N [25] Training | 2017 | China | PDAC | 220 | 2007–2016 | R | 0.46 by ROC | 98 | 122 | Curative resection | OS | 1.82 (1.34–2.47) | Crude (U) | Median 15 (1–105) |
OS | 2.09 (1.27–3.42) | Crude (M) | ||||||||||||
Pu N [25] Validation | 2017 | China | PDAC | 134 | 2007–2016 | R | 0.46 by ROC | 35 | 99 | Curative resection | OS | 2.16 (1.35–3.43) | Crude (U) | Median 15 (1–105) |
OS | 2.18 (1.04–4.53) | Crude (M) | ||||||||||||
Nie M [26] | 2017 | China | NPC | 209 | 2008–2011 | R | 0.447 by ROC | 142 | 67 | Chemotherapy | OS | 2.87 (1.97–4.17) | Crude (U) | Median 16.6 (1–66.6) |
OS | 3.27 (1.71–6.25) | Crude (M) | ||||||||||||
PFS | 1.76 (1.27–2.42) | Crude (U) | ||||||||||||
PFS | 2.30 (1.22–4.33) | Crude (M) | ||||||||||||
Chan AW [9] Training | 2015 | HongKong | HCC | 217 | 2001–2006 | R | 0.23 by ROC | 199 | 18 | Curative resection | OS | 3.35 (1.97–5.70) | Crude (U) | Median 44.5 (0.1–160.7) |
OS | 2.36 (1.35–4.10) | Crude (M) | ||||||||||||
DFS | 2.46 (1.55–3.92) | Crude (U) | ||||||||||||
DFS | 1.85 (1.16–2.96) | Crude (M) | ||||||||||||
Chan AW [9] Validation 2 | 2015 | HongKong | HCC | 425 | 2007–2011 | R | 0.23 by ROC | 200 | 225 | Palliative treatment | OS | 2.19 (1.78–2.68) | Crude (M) | Median 5.3 (0.1–62.6) |
Chan AW [9] Validation 1 | 2015 | HongKong | HCC | 256 | 2006–2011 | R | 0.23 by ROC | 241 | 14 | Curative resection | OS | 1.93 (1.06–3.50) | Crude (M) | Median 38.9 (0.1–95.4) |
DFS | 1.58 (1.01–2.46) | Crude (M) |
Meta-analysis with OS
Meta-analysis with DFS
Meta-analysis with PFS and CSS
Stratification for OS from univariate analysis
Factor for stratification | No. of Cohorts | No. of Cases | No.of Low AAPR | N. of High AAPR | Pooled Data | Test for Heterogeneity | |||
---|---|---|---|---|---|---|---|---|---|
HR | 95%CI | P value | I2 (%) | P value | |||||
Overall calculation | 20 | 5921 | 2495 | 3426 | 2.14 | 1.83–2.51 | < 0.001 | 62.2 | 0.000 |
Year of publication | |||||||||
After 2019 | 14 | 4077 | 1491 | 2586 | 2.20 | 1.85–2.63 | < 0.001 | 43.0 | 0.044 |
Before 2019 | 6 | 1844 | 1004 | 840 | 2.02 | 1.50–2.71 | < 0.001 | 78.9 | 0.000 |
Cancer site | |||||||||
Liver cancer | 5 | 997 | 479 | 508 | 1.96 | 1.37–2.80 | < 0.001 | 75.4 | 0.003 |
Lung cancer | 5 | 1522 | 736 | 786 | 2.03 | 1.52–2.70 | < 0.001 | 67.1 | 0.016 |
Others | 10 | 3412 | 1280 | 2312 | 2.32 | 1.92–2.80 | < 0.001 | 25.9 | 0.205 |
Sample size | |||||||||
≥ 224 | 11 | 4417 | 1873 | 2544 | 2.06 | 1.64–2.58 | < 0.001 | 69.2 | 0.000 |
< 224 | 9 | 1504 | 622 | 882 | 2.24 | 1.86–2.71 | < 0.001 | 35.9 | 0.131 |
Cut-off value for AAPR | |||||||||
≥ 0.487 | 7 | 2931 | 1457 | 1474 | 2.25 | 1.75–2.88 | < 0.001 | 44.6 | 0.094 |
< 0.487 | 13 | 2990 | 1038 | 1952 | 2.10 | 1.72–2.56 | < 0.001 | 67.0 | 0.000 |
Study design type | |||||||||
Prospective | 1 | 390 | 212 | 178 | 4.76 | 2.56–8.33 | < 0.001 | – | – |
Retrospective | 19 | 5531 | 2283 | 3248 | 2.05 | 1.77–2.37 | < 0.001 | 55.8 | 0.002 |
Treatment strategy | |||||||||
Resection | 11 | 3936 | 1630 | 2306 | 2.20 | 1.95–2.50 | < 0.001 | 47.9 | 0.038 |
Others | 9 | 1985 | 865 | 1120 | 1.64 | 1.46–1.86 | < 0.001 | 60.2 | 0.010 |
HR source | |||||||||
Crude | 16 | 5049 | 2287 | 2762 | 2.14 | 1.85–2.47 | < 0.001 | 40.4 | 0.053 |
Estimated | 4 | 872 | 208 | 664 | 2.21 | 1.42–3.44 | < 0.001 | 79.2 | 0.001 |
Follow-up interval | |||||||||
≥ 5 years | 11 | 3385 | 1171 | 2214 | 2.36 | 1.81–3.06 | < 0.001 | 70.1 | 0.000 |
< 5 years | 9 | 2536 | 1324 | 1212 | 2.01 | 1.66–2.42 | < 0.001 | 51.8 | 0.035 |