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Clinicopathological and prognostic value of DLL4 expression in gastric cancer: A systematic review and meta-analysis
Qingyu Du1,2, Chenglin Zhao1,2, Chunling Sun3
1Department of Gastrointestinal Surgery, Central Hospital of Dalian University of Technology (Dalian Municipal Central Hospital), China.
Background:
The clinicopathological significance and prognostic value of Delta-like ligand 4 (DLL4) expression in gastric cancer (GC) remain controversial. Therefore, we conducted a meta-analysis to ascertain the correlation between DLL4 expression and the clinicopathological features and prognosis of GC patients.
Objectives:
To clarify the association between DLL4 expression, clinicopathological parameters, and the prognosis of GC patients, as well as to resolve the existing controversies.
Material And Methods:
A systematic retrieval was performed according to the selection criteria. The hazard ratio (HR) or odds ratio (OR) and 95% confidence interval (95% CI) were applied to assess the clinicopathological and prognostic value of DLL4 expression in patients with GC.
Results:
A total of 1,535 patients with GC were included across 7 articles. DLL4 expression was correlated with lymph node metastasis (OR = 5.612, 95% CI: 1.332-23.644; p = 0.019), venous invasion (OR = 3.807, 95% CI: 1.557-9.310, p = 0.003), and TNM stage (OR = 4.183, 95% CI: 1.270-13.775, p = 0.003). However, DLL4 expression was not related to sex (OR = 0.976, 95% CI: 0.767-1.242, p = 0.845), age (OR = 0.765, 95% CI: 0.389-1.506, p = 0.438), T stage (OR = 1.306, 95% CI: 0.717-2.380, p = 0.384), tumor differentiation (OR = 0.952, 95% CI: 0.687-1.318, p = 0.072), or Lauren classification (OR = 1.224, 95% CI: 0.620-2.417, p = 0.560). Furthermore, high DLL4 expression was associated with poorer overall survival (OS) (HR = 1.530, 95% CI: 1.272-1.841, p = 0.000) in patients with GC. The Kaplan-Meier Plotter database confirmed that patients with high DLL4 expression in GC had a poorer prognosis (HR = 1.35, 95% CI: 1.08-1.68, p = 0.009).
Conclusion:
DLL4 expression was associated with venous invasion, lymph node metastasis, TNM stage, and poor OS in GC patients, but was not associated with age, sex, T stage, Lauren classification, or tumor differentiation.