Prognostic value of circulating uric acid in gastrointestinal cancers, a systematic review and meta-analysis

Abstract

Aim: Thus, this meta-analysis was performed to assess the prognostic value of serum uric acid in patients with gastrointestinal cancers (GI).

Background: There is growing evidence that high serum uric acid may be used as a potential prognostic marker in gastrointestinal malignancies. However, there are inconsistencies in the reported findings.

Methods: Related studies were identified by searching the following databases: PubMed, Web of Science, Cochrane Library, and Scopus, independently up until 30 October 2023. Relevant analyses were carried out to deal with heterogeneity in the data. According to the inclusion criteria, we used English original papers reporting prognostic value of serum/plasma uric acid to determine hazard ratio (HR) and 95% confidence interval (CI) in patients with GI cancers. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to ascertain the association of uric acid levels with gastrointestinal cancer (GI) risk. The inconsistency index (I2) was used to calculate the level of heterogeneity among the selected studies. The quality of each study was evaluated by Newcastle-OTTAWA Scales (NOS).

Results: A total of 9 papers with 95.285 patients were included in this meta-analysis. The findings indicated a significant association between serum uric acid and poor prognosis in patients with gastrointestinal cancers (HR=1.477, 95% CI 1.165-1.873, P= 0.001). Further, in Subgroup analysis we found that patients would have poor survival rate among different cut-offs of uric acid, ≥ 5mg/dl, HR= 1.403, 95% CI=1.150-1.711, P=0.001 vs cut-off <5mg/dl, HR=1.54, 95% CI=1.140-2.063, P=0.005.

Conclusion: Serum uric acid level is significantly linked to survival outcomes in patients with gastrointestinal cancers. Serum uric acid levels may be an effective prognostic marker associated with clinical outcomes in patients with gastrointestinal cancers. Given the small number of studies included in this meta-analysis and high heterogeneity, we suggest that a more comprehensive study is required to achieve more robust results.

Keywords: Gastrointestinal cancers; Hazard ratio; Prognosis; Survival; Uric acid.

Figure 1

Flow diagram of the papers selection

Figure 2

Forest plots (random-effect model) of pooled hazard ratio (HR) for the association of circulating uric acid with overall survival. Due to high heterogeneity, the random effect was used (I2=97.22; P value=0.00).

Figure 3

Subgroup analysis of Forest plots of HR 95% CI based on uric acid cut off (A), ethnicity (B), sample size (C) and following up time points (year) (D). HR: hazard ratio, CI: confidence interval

Figure 4

Sensitivity analysis of the included studies.

Figure 5A

Begg’s funnel plot with pseudo 95% CI

Figure 5B

The result of Duval and Tweedie’s trim and fill test (two study was trimmed)