Prognostic and clinicopathological value of Gli-1 expression in gastric cancer: A meta-analysis

Glioma associated oncogene-1 (Gli-1) is considered as a strong positive activator of downstream target genes of hedgehog signal pathway in mammalians. However, its diagnostic and prognostic value in gastric cancer remains unclear and controversial. Therefore, a quantitative meta-analysis was conducted to determine the clinical value of Gli-1 in gastric cancer patients. Twelve eligible articles with 886 gastric cancer patients were included in this meta-analysis. The relationship between Gli-1 expression in gastric cancer patients and clinicopathological features and 5-year overall survival (OS) was evaluated using pooled odds ratios (ORs) and hazard ratio (HR) with 95% confidence intervals (CIs). The meta-analysis showed that the upregulated Gli-1 was associated with sample type (gastric cancer tissues) (OR 10.31, 95%CI 7.14-14.88; P = 0.000), differentiation type (OR 3.76, 95%CI 2.55-5.53; P = 0.000), depth of invasion (OR 8.17, 95%CI 3.60-18.55; P = 0.000), lymph node metastasis (OR 3.97, 95%CI 2.73-5.78; P = 0.000) and high TNM stage (OR 3.65, 95%CI 1.89-7.04; P = 0.000). Three studies including 316 patients were assessed for the correlation between Gli-1 and 5-year OS, which indicated that positive Gli-1 expression was associated with poor prognosis in gastric cancer patients (HR 2.14, 95%CI 1.35-3.40; P = 0.001). Little publication bias was identified by funnel plots and Egger's tests. The sensitivity analysis indicated that no study substantially influenced pooled OR/HR. Taken together, Gli-1 is a credible indicator for highly aggressive tumor with poor prognosis in gastric cancer patients.