Potential Role of miR-196a and miR-196b as Prognostic Biomarkers of Survival in Head and Neck Squamous Cell Carcinoma: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

The etiopathogenetic mechanisms involving tumor genesis, including alteration of cell proliferation, apoptosis, invasion, migration, and death, may lead to alterations in microRNAs (miR) expression. The hypothesis is that with the presence in the literature of recent studies conducted on miR-196a and miR-196b, it is possible to clearly determine, by aggregating the results, whether miR-196 upregulation in head and neck squamous cell carcinoma (HNSCC) tissues can represent a prognostic biomarker of survival through hazard ratio (HR) analysis. The systematic review was conducted following the indications of the PRISMA, and four electronic databases were used (Science Direct, SCOPUS, PubMed, and Cochrane Central), with the addition of gray literature. Combinations of keywords were used, such as miR-196, miR-196 AND HNSCC, microRNA AND HNSCC, LSCC AND miR-196, OSCC AND miR-196, OPSCC AND miR-196, HSCC AND miR-196. The meta-analysis and trial sequential analysis (TSA) were performed using RevMan 5.41 software and Stata 13 (StataCorp, College Station, TX, USA) with the implementation of the R 4.2 software. This search identified 1593 reports and, at the end of the selection, five articles were inserted. The results of the meta-analysis report an aggregate HR for overall survival (OS), between the highest and lowest miR-196 expression of 1.67, 95% CI: [1.16, 2.49]. In this meta-analysis, we found that the forest plot is in favor of higher OS in HNSCC patients, compared with the control, with low miR-196 expression, correlating this data with a favorable prognosis, which indicated the potential role of this miRNA in strengthening the therapy sensitiveness of the HNSCC patients. Consequently, the present systematic review places itself, together with other systematic reviews on this topic, in a key role to the finding of Phase 3 clinical trials studies, in search for a prognostic model of miR-196 for HNSCC. In conclusion, with the limitations of the meta-analysis, it can be argued that miRs of the miR-196 family could be independent prognostic biomarkers of survival for HNSCC.