Immunohistochemical detection of cancer-associated fibroblasts in gastrointestinal cancer as a potential prognostic biomarker of survival: meta-analysis

BACKGROUND: The association between cancer-associated fibroblasts (CAFs) and prognosis of gastrointestinal cancer patients remains controversial. The purpose of the present article is to assess the role of CAFs in gastrointestinal cancer patients by performing a meta-analysis of the clinical trials published in the literature. METHODS: Several studies were conducted to compare survival between high proportion of CAFs and low proportion of CAFs in gastrointestinal cancer patients. Search strategies were performed in PubMed, EMBASE, Medline and the Cochrane Library database. Methodological quality was assessed with the Newcastle-Ottawa Quality Assessment Scale (NOS). RESULTS: Among 3,763 patients enrolled in 18 studies, the pooled hazard ratio (HR) 1.64 (95% CI, 1.43 to 1.87; P<0.001) for overall survival (OS) indicated that a high proportion of CAFs was associated with shorter OS. Among 3,137 patients in 7 studies, the pooled HR 2.56 (95% CI, 1.55 to 4.22, P<0.001) for disease-free survival (DFS) exhibited that a high proportion of CAFs was associated with higher risk of recurrence. The subgroup analyses based on different tumor types showed consistent results. CAFs had no correlation with age, gender, tumor localization, TNM stage, tumor grade, and tumor type. CONCLUSIONS: The meta-analysis indicates that high proportion of CAFs is a valuable predictor of the prognosis in gastrointestinal cancer patients, and it may provide new ideas for targeted therapy in gastrointestinal cancer patients.