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Meta-Analysis
. 2012;7(12):e50946.
doi: 10.1371/journal.pone.0050946. Epub 2012 Dec 28.

Prognostic significance of tumor-associated macrophages in solid tumor: a meta-analysis of the literature

Qiong-wen Zhang  1 , Lei Liu, Chang-yang Gong, Hua-shan Shi, Yun-hui Zeng, Xiao-ze Wang, Yu-wei Zhao, Yu-quan Wei
Affiliations
Meta-Analysis

Prognostic significance of tumor-associated macrophages in solid tumor: a meta-analysis of the literature

Qiong-wen Zhang et al. PLoS One. 2012.

Abstract

Purpose: Tumor associated macrophages (TAMs) are considered with the capacity to have both negative and positive effects on tumor growth. The prognostic value of TAM for survival in patients with solid tumor remains controversial.

Experimental design: We conducted a meta-analysis of 55 studies (n = 8,692 patients) that evaluated the correlation between TAM (detected by immunohistochemistry) and clinical staging, overall survival (OS) and disease free survival (DFS). The impact of M1 and M2 type TAM (n = 5) on survival was also examined.

Results: High density of TAM was significantly associated with late clinical staging in patients with breast cancer [risk ratio (RR) = 1.20 (95% confidence interval (CI), 1.14-1.28)] and bladder cancer [RR = 3.30 (95%CI, 1.56-6.96)] and with early clinical staging in patients with ovarian cancer [RR = 0.52 (95%CI, 0.35-0.77)]. Negative effects of TAM on OS was shown in patients with gastric cancer [RR = 1.64 (95%CI, 1.24-2.16)], breast cancer [RR = 8.62 (95%CI, 3.10-23.95)], bladder cancer [RR = 5.00 (95%CI, 1.98-12.63)], ovarian cancer [RR = 2.55 (95%CI, 1.60-4.06)], oral cancer [RR = 2.03 (95%CI, 1.47-2.80)] and thyroid cancer [RR = 2.72 (95%CI, 1.26-5.86)],and positive effects was displayed in patients with colorectal cancer [RR = 0.64 (95%CI, 0.43-0.96)]. No significant effect was showed between TAM and DFS. There was also no significant effect of two phenotypes of TAM on survival.

Conclusions: Although some modest bias cannot be excluded, high density of TAM seems to be associated with worse OS in patients with gastric cancer, urogenital cancer and head and neck cancer, with better OS in patients with colorectal cancer.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of the literature search and selection of included studies.
Figure 2
Figure 2. Forrest plots and meta-analysis of studies evaluating RR of high TAM counts as compared to low counts.
Clinical staging and survival data are reported as (A) staging, (B) overall survival (OS) and (C) disease free survival (DFS).
Figure 3
Figure 3. Forrest plots and meta-analysis of studies evaluating RR of high TAM counts as compared to low counts in different subgroup of tumors.
Clinical staging and survival data are reported as (A) gastrointestinal cancer, (B) urogenital cancer, (C) lung cancer and (D) head and neck cancer.
Figure 4
Figure 4. Funnel graph for assessment of potential publication bias in studies of TAM density in patients with solid tumor.
(A) Staging, (B) OS, (C) DFS. The funnel graph plots log HR against the standard error of the log HR. The result of the Egger's test showed no statistical significant (p>0.05).
See this image and copyright information in PMC

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