Vasculogenic mimicry as a poor diagnostic and prognostic indicator in patients with malignant melanoma: A systematic review and meta-analysis
Abstract Background Vasculogenic mimicry (VM), a brand-new tumor microvascular model of non-endothelial cells, is proposed as an important therapeutic target in malignant melanoma (MM). We performed a systematic review to evaluate the diagnostic and prognostics accuracy of VM for overall survival of MM patients. Methods The quality of the included studies was assessed by QUADAS-2 tool. Diagnostic capacity of VM variables were pooled by the Meta-Disc software in term of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC). Results A retrospective observational study was conducted based on ten studies including 978 clinically melanoma patients with proportion (P). VM+ melanoma cells are associated with poor prognosis in 38% of MM group (P = 0.35, 95% confidence intervals (CI): 0.27-0.42, P-value < 0.001). The pooled sensitivity and specificity were 0.82 (95% CI: 0.79-0.84) and 0.69 (95% CI: 0.66-0.71), respectively. Furthermore, the pooled PLR, NLR, and DOR were 2.56 (95% CI: 1.94-3.93), 0.17 (95% CI: 0.07-0.42), and 17.75 (95% CI: 5.30-59.44), respectively. Also, the AUC of SROC was 0.63, indicating the highly conserving of VM as a biomarker. Importantly, subgroup results suggested that VM+ tumor was significantly accurate prognostics biomarkers when diagnosed by CD31-/PAS+ staining methods in Asian MM samples (P-value > 0.001). Conclusions Our finding supports the VM+ tumor as a promising prognostic biomarker and effective adjuvant therapeutic strategy in prognostics of Asian MM patients.