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Meta-Analysis
. 2019 Feb 22;19(1):168.
doi: 10.1186/s12885-019-5375-0.

Prognostic value of performance status in metastatic renal cell carcinoma patients receiving tyrosine kinase inhibitors: a systematic review and meta-analysis

Yawei Xu  1 , Yuanyuan Zhang  2 , Xianhao Wang  1 , Jiaqi Kang  1 , Xiaoqiang Liu  3
Affiliations
Meta-Analysis

Prognostic value of performance status in metastatic renal cell carcinoma patients receiving tyrosine kinase inhibitors: a systematic review and meta-analysis

Yawei Xu et al. BMC Cancer. .

Abstract

Background: The association between performance status (PS) and the prognosis of metastatic renal cell carcinoma (mRCC) patients receiving tyrosine kinase inhibitors (TKIs) remains controversial. The aim of this study is to evaluate the prognostic value of PS in mRCC patients treated with TKIs.

Methods: Electronic databases were searched to identify the studies that had assessed the association between pretreatment PS and prognosis in mRCC patients receiving TKIs. Hazard ratios (HRs) and 95% confidence interval (CI) for overall survival (OS) and progression-free survival (PFS) from eligible studies were used to calculate combined HRs. The heterogeneity across the included studies was assessed by Cochrane's Q test and I2 statistic. The Begg's funnel plot and Egger's linear regression teats were used to evaluate the potential publication bias. The meta-analysis was performed with RevMan 5.3 and Stata SE12.0 according to the PRISMA guidelines.

Results: A total of 6780 patients from 19 studies were included in this meta-analysis. The results showed that a poor PS was an effective prognostic factor of both OS (pooled HR: 2.08, 95% CI: 1.78-2.45) and PFS (pooled HR: 1.51, 95% CI: 1.20-1.91). Subgroup analysis revealed that poor PS significantly associated with poor OS and PFS in studies using Karnofsky PS scale (OS, pooled HR: 2.20, 95% CI: 1.65-2.94; PFS, pooled HR: 1.74, 95% CI: 1.19-2.56), conducted in Asia (OS, pooled HR: 2.25, 95% CI: 1.71-2.95; PFS, pooled HR: 1.73, 95% CI: 1.14-2.64) and Newcastle-Ottawa Scale score of 8 (OS, pooled HR: 2.61, 95% CI: 1.92-3.55; PFS, pooled HR: 2.43, 95% CI: 1.36-4.33).

Conclusions: This study suggests that a poor PS is significantly associated with poor prognosis in mRCC patients receiving TKIs.

Keywords: Metastatic renal cell carcinoma; Mete-analysis; Performance status; Prognosis.

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Conflict of interest statement

Ethics approval and consent to participate

All the procedures performed were in full accordance with the ethical standards of the appropriate national and institutional committees on human experimentation and with the Helsinki Declaration. This study was approved by the institution Ethics Commission of Tianjin Medical University General Hospital and the Second Hospital of Tianjin Medical University. The need for consent to participate was waived by Ethics Commission of Tianjin Medical University General Hospital and the Second Hospital of Tianjin Medical University.

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-analysis flow diagram: search and study selection process for this review
Fig. 2
Fig. 2
Forest plot showing the effects of PS on a overall survival b progression-free survival in mRCC patients receiving TKIs
Fig. 3
Fig. 3
Funnel plots based on overall survival a Begg’s test b Egger’s test; and progression-free survival c Begg’s test d Egger’s test
Fig. 4
Fig. 4
Sensitivity analysis in this mate-analysis. a sensitivity analysis for overall survival; b sensitivity analysis for progression-free survival
See this image and copyright information in PMC

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