Wilms' tumor 1 (WT1) expression and prognosis in solid cancer patients: a systematic review and meta-analysis

Abstract

Though proposed as a promising target antigen for cancer immunotherapy, the prognostic value of Wilms' tumor 1 (WT1) in solid tumors remains inconclusive. Here, we report a systematic review and meta-analysis of the association between WT1 expression and prognosis in solid tumors. PubMed, Web of Science and Google Scholar were searched to identify studies exploring the impact of WT1 on clinical outcomes, including overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), relapse/recurrence-free survival (RFS) or progression-free survival (PFS), in solid cancer patients. Hazard ratio (HR) and 95% confidence interval (CI) were applied to assess the strength of these associations. Finally, a total of 29 eligible studies with 4090 patients were identified for qualitative analysis, and 22 studies with 3620 patients were enrolled for quantitative synthesis. Overall, positive expression of WT1 was significantly associated with worse OS (metaHR = 1.48, 95% CI = 1.11-1.97) and DFS/RFS/PFS (metaHR = 2.14, 95% CI = 1.42-3.21). Subgroup analyses showed that WT1 positive expression could independently predict unfavorable DFS/RFS/PFS (metaHR = 1.86, 95%CI = 1.04-3.35). In summary, our study suggests that WT1 may be a potential marker to predict DFS/RFS/PFS in solid tumor patients. Further studies are needed to confirm the role of WT1 expression in clinical practice.

Figure 1. Flow diagram of study identification.

Figure 2. Meta-analysis of impact of WT1 expression on overall survival of patients with solid tumors.

Results are presented as individual and metaHR, and 95% CI.

Figure 3. Meta-analysis of impact of WT1 expression on disease-specific survival of patients with solid tumors.

Results are presented as individual and metaHR, and 95% CI.

Figure 4. Meta-analysis of impact of WT1 expression on disease-free survival/progression-free survival/relapse or recurrence-free survival of patients with solid tumors.

Results are presented as individual and metaHR, and 95% CI.

Figure 5. Funnel plot for the evaluation of potential publication bias in the impact of WT1 on overall survival (A), disease-specific survival (B) and disease-free survival/progression-free survival/relapse or recurrence-free survival (C) of patients with solid tumors.

The funnel graph plots the log of HR against the standard error of the log of the HR (an indicator of sample size). The circles indicate the individual studies in the meta-analysis. The line in the center represents the metaHR.