Prognostic and clinicopathological value of FoxM1 expression in colorectal cancer: A systematic review and meta-analysis

Abstract

Background: The study aims to assess the relationship between FoxM1 expression and clinicopathological parameters and prognosis of patients diagnosed with colorectal cancer (CRC) by summarizing the studies included.

Methods: PubMed, EMBASE, The Cochrane Library and other sources were searched for relative studies. Odds ratio (OR) and confidence interval (CI) were used to assess association between FoxM1 expression and clinical parameters and prognosis of CRC patients.

Results: Eight studies were included in the final analysis, with 1149 CRC patients. The outcome revealed that expression of FoxM1 was associated with lymph node metastasis (OR = 0.33, 95%CI = 0.19-0.62, P < .001), distant metastasis (OR = 0.35, 95%CI = 0.24-0.46, P < .001) and tumor node metastasis (TNM) stage (OR = 0.45, 95%CI = 0.29-0.72, P < .001). Meanwhile, reduced FoxM1 expression indicated higher 5-year survival rate (OR = 0.38, 95%CI = 0.18-0.78, P = .01). Expression of FoxM1 was also increased obviously in CRC tissues (OR = 13.04, 95%CI = 4.07-41.71, P < .001).

Conclusion: This pooled analysis indicated that FoxM1 expression related to lymph node metastasis, distant metastasis, TNM stage and poor prognosis of the CRC patients.

Figure 1

Flow diagram of study selection.

Figure 2

Assessment of risk of bias. A: Methodological quality graph: authors’ judgment about each methodological quality item presented as percentages across all included studies; B: Methodological quality summary: authors’ judgment about each methodological quality item for each included study, "+” low risk of bias; "?” unclear risk of bias; "-” high risk of bias.

Figure 3

The forest plot of ORs for the association between FoxM1 expression and the A: gender, B: age, C: differentiation, D: lymph node metastasis, E: distant metastasis, F: TNM stage. FoxM1 = Forkhead box M1, OR = odds ratio, TNM = tumor node metastasis.

Figure 4

The forest plot showed the analysis for 5-year survival of CRC patients according to FoxM1 expression (A), funnel plots for publication bias (B) and sensitivity analysis (C) of comparisons between expression of FoxM1 and 5-year survival. CRC = colorectal cancer, FoxM1 = Forkhead box M1.

Figure 5

Funnel plots for publication bias. A: gender, B: age, C: differentiation, D: lymph node metastasis, E: distant metastasis, F: TNM stage. TNM = tumor node metastasis.

Figure 6

Sensitivity analysis. A: gender, B: age, C: differentiation, D: lymph node metastasis, E: distant metastasis, F: TNM stage. TNM = tumor node metastasis.