Prognostic significance of NANOG expression in solid tumors: a meta-analysis
Received 29 March 2018
Accepted for publication 23 June 2018
Published 6 September 2018 Volume 2018:11 Pages 5515—5526
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 4
Editor who approved publication: Dr Samir Farghaly
Lingqiong Zhao,1,* Jie Liu,2,* Shu Chen,1 Chun Fang,1 Xianquan Zhang,1 Zhibin Luo3
1Department of Oncology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; 2Department of Cardiology, The Affiliated Hospital of North Sichuan Medical College, Sichuan 637000, China; 3Department of Oncology, Chongqing General Hospital, Chongqing 400010, China
*These authors contributed equally to this work
Purpose: NANOG is a tumor marker and indicates poor prognosis in various neoplasms; however, the evidence is controversial. This meta-analysis investigated the association of NANOG expression and clinicopathological features, and it impact on survival of patients with malignant tumors.
Methods: Studies published through May 31, 2018 were retrieved from PubMed, Web of Science, Embase, and the China National Knowledge Infrastructure. Two researchers independently screened the content and quality of studies and extracted data. Correlations of NANOG expression, clinicopathological variables, and survival were analyzed and the combined odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated.
Results: Thirty-three articles including 35 data sets of 3,959 patients were analyzed. Overall, elevated NANOG expression was associated with poor overall survival (HR = 2.19; 95% CI: 1.87–2.58, P<0.001) and poor disease-free survival (HR = 2.21, 95% CI: 1.54–3.18, P<0.001). Subgroup analysis found that NANOG expression was associated with worse overall survival in non–small cell lung (HR = 1.87; 95% CI: 1.26–2.76, P = 0.002), head and neck (HR = 2.29; 95% CI: 1.75–3.02, P<0.001), and digestive system (HR = 2.38; 95% CI: 1.95–2.91, P<0.001) cancers. Moreover, we found that high NANOG expression was associated with poor tumor differentiation (OR = 2.63; 95% CI: 1.59–4.55, P = 0.001), lymph node metastasis (OR = 2.59; 95% CI: 1.50–4.47, P = 0.001), advanced TNM stage (OR = 2.22; 95% CI: 1.42–3.45, P<0.001), and T stage (OR = 0.44; 95% CI: 0.20–0.93, P = 0.031).
Conclusion: The evidence supports NANOG as a tumor biomarker to guide clinical management and indicate prognosis. Additional studies are needed to further validate these results.
Keywords: NANOG, cancer, prognosis, meta-analysis
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