High mobility group A protein-2 as a tumor cancer diagnostic and prognostic marker: a systematic review and meta-analysis

Abstract

High mobility group A protein-2 (HMGA2) is an architectural transcription factor that binds to the A/T-rich DNA minor groove and is responsible for regulating transcriptional activity of multiple genes indirectly through chromatin change and assembling enhanceosome. HMGA2 is overexpressed in multiple tumor types, suggesting its involvement in cancer initiation and progression, thus, making it an ideal candidate for cancer diagnostic and prognostic. We performed a systematic review to examine the role of HMGA2 as a universal tumor cancer diagnostic and prognostic marker. We used Reporting Recommendations for Tumor Marker Prognostic Studies to systematically search OvidMedline, PubMed, and the Cochrane Library for English language studies, published between 1995 and June 2019. Meta-analysis provided pooled risk estimates and their 95% confidence intervals (CIs) for an association between overall survival and recurrence of cancers for studies with available estimates. We identified 42 eligible studies with a total of 5123 tumor samples in 15 types of cancer. The pooled percentage of HMGA2 gene expression in tumor samples was 65.14%. Meta-analysis showed that cancer patients with HMGA2 positive have significantly reduced survival, compared to patients without HMGA2 gene [pooled-hazard ratio (HR) = 1.85, 95% CI 1.48-2.22]. There was a positive association between cancer patients with HMGA2 overexpression and cancer recurrence though this association did not reach significance (pooled-HR = 1.44, 95% CI 0.80-2.07). Overexpression of HMGA2 was found in 15 types of cancer. There was an association between HMGA2 overexpression with reduced survival of cancer patients. HMGA2 is thus considered a promising universal tumor marker for prognostics.

Fig. 1

Search strategy and screening for eligibility for current systematic review. REMARK, Reporting Recommendations for Tumor Marker Prognostic Studies.

Fig. 2

(a) Overall survival of cancers with HMGA2 positive vs. HMGA2 negative (using immunohistochemistry testing method only). (b) Funnel plots of publication bias in the overall survival of cancers with HMGA2 positive vs. HMGA2 negative.

Fig. 3

(a) Recurrence of Cancers with HMGA2 positive vs. HMGA2 negative (using immunohistochemistry testing method only). (b) Funnel plots of publication bias recurrence of cancers with HMGA2 positive vs. HMGA2 negative.