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Meta-Analysis
. 2020 Mar;99(11):e19438.
doi: 10.1097/MD.0000000000019438.

The association between pretreatment serum alkaline phosphatase and prognosis in hepatocellular carcinoma: A meta-analysis

Ping Sun  1 , Shihai Chen  2 , Yanlong Li  1
Affiliations
Meta-Analysis

The association between pretreatment serum alkaline phosphatase and prognosis in hepatocellular carcinoma: A meta-analysis

Ping Sun et al. Medicine (Baltimore). 2020 Mar.

Abstract

Background: Numerous studies have investigated the association between pretreatment serum alkaline phosphatase (ALP) and prognosis in hepatocellular carcinoma (HCC), but conclusions remain controversial. Thus, we performed a meta-analysis to assess systematically the relationship between ALP and prognosis in HCC.

Methods: We searched the PubMed, EMBASE, and Web of Science databases for eligible studies up to October. A combined hazard ratio (HR) was determined to describe the correlation between pretreatment serum ALP level and prognosis in HCC patients. Overall survival (OS) was calculated from the date of treatment either to the end point of the follow-up period or to the date of death by any cause. Disease-free survival (DFS) and recurrence-free survival (RFS) were defined as the period from the date of treatment to the date of last follow-up or to the date of recurrence. OS was regarded as the major outcome.

Results: Altogether, 21 studies about OS and 6 studies about DFS/RFS were included in this meta-analysis. Our combined results showed that there was an inverse association of pretreatment serum ALP level with OS (HR=1.15, 95% CI: 1.12-1.19) and RFS (HR=1.78, 95% CI: 1.37-2.31).

Conclusion: There was a close association between high pretreatment ALP level and poor survival in HCC patients, indicating that ALP may be used as a biomarker for prognosis. More high-quality studies are required to validate our findings further, considering the limitations of our meta-analysis.

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Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the literature selection process.
Figure 2
Figure 2
Meta-analysis of the association between pretreatment serum alkaline phosphatase levels and overall survival in hepatocellular carcinoma patients.
Figure 3
Figure 3
Meta-analysis of the association between serum ALP level and disease-free survival/recurrence-free survival (in HCC patients.
Figure 4
Figure 4
Subgroup analysis by the cut-off for high alkaline phosphatase level for the pooled result of overall survival.
Figure 5
Figure 5
Subgroup analysis by primary treatment type for the pooled result of overall survival.
Figure 6
Figure 6
Subgroup analysis by mean age for the pooled result of overall survival.
Figure 7
Figure 7
Subgroup analysis by survival analysis type for the pooled result of OS, overall survival.
Figure 8
Figure 8
Funnel plot of publication bias assessment for OS (A) and the adjusted funnel plots of publication bias assessment for OS (B). OS = overall survival.
See this image and copyright information in PMC

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