血清尿酸与鼻咽癌预后之间的关联：一项观察性研究的综合荟萃分析

文献信息

中文摘要

背景： 目前，血清尿酸（SUA）在鼻咽癌（NPC）中的预后价值仍存在争议，相关临床证据缺乏系统、全面的验证。本研究是首个综合汇总不同治疗方案证据的荟萃分析，旨在系统评价血清尿酸（SUA）水平与NPC患者生存结局之间的关联。
方法： 本荟萃分析严格按照系统评价和荟萃分析首选报告条目（PRISMA）指南进行。从国内外电子数据库中系统检索了关注SUA在NPC中预后作用的合格临床研究。所有检索到的文献均依据预先设定的纳入和排除标准进行严格筛选。纳入研究的方法学质量采用纽卡斯尔-渥太华量表（NOS）进行评估。文献筛选、数据提取和质量评价由两名研究者独立进行，任何分歧均通过协商或咨询第三位资深研究者解决。提取关键预后数据，包括总生存期（OS）、无进展生存期（PFS）和无远处转移生存期（DMFS）的风险比（HR）及其95%置信区间（CI），并进行定量合并分析，以评价SUA在NPC中的预后意义。
结果： 合并结果显示，SUA升高与NPC患者的OS显著相关，合并HR为0.245（95% CI：0.092-0.398）。相比之下，SUA水平与PFS或DMFS之间未观察到具有统计学意义的关联。PFS的合并HR为0.557（95% CI：0.070-1.044），DMFS的合并HR为0.715（95% CI：0.023-1.407）。PFS和DMFS的95% CI均跨越无效值1，表明无显著统计学差异。
结论： SUA水平是NPC患者OS的独立预后因素，较高的尿酸水平可能改善患者的总生存期。在NPC患者中未发现SUA水平与PFS或DMFS之间存在显著相关性。SUA可能作为一种新型、便捷、无创的生物标志物用于NPC的预后评估，并可能为预后风险分层和个体化管理提供参考。尚需进一步开展大样本、高质量的前瞻性队列研究以验证本研究发现。
系统评价注册： https://www.crd.york.ac.uk/PROSPERO/view/CRD420261483250，注册号CRD420261483250。

英文摘要

BACKGROUND: At present, the prognostic value of serum uric acid (SUA) in Nasopharyngeal carcinoma (NPC) remains controversial, and relevant clinical evidence lacks systematic and comprehensive verification. This the first-ever meta-analysis comprehensively synthesized evidence across various regimens to systematically evaluate the association between serum uric acid (SUA) levels and survival outcomes in NPC patients.
METHODS: This meta-analysis was strictly performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible clinical studies focusing on the prognostic role of SUA in NPC were systematically retrieved from domestic and international electronic databases. All retrieved literatures were screened strictly based on predefined inclusion and exclusion criteria. The methodological quality of enrolled studies was assessed using the Newcastle-Ottawa Scale (NOS). Literature screening, data extraction, and quality evaluation were independently conducted by two investigators, and any discrepancies were resolved by consensus or consultation with a third senior researcher. Key prognostic data including hazard ratios (HR) with 95% confidence intervals (CI) for Overall Survival (OS), Progression-Free Survival(PFS), and Distant Metastasis-Free Survival (DMFS) were extracted and pooled for quantitative analysis to evaluate the prognostic significance of SUA in NPC.
RESULTS: The pooled results demonstrated that elevated SUA was significantly correlated with OS in NPC patients, with a combined HR of 0.245 (95% CI: 0.092-0.398). In contrast, no statistically significant associations were observed between SUA levels and PFS or DMFS. The pooled HR for PFS was 0.557 (95% CI: 0.070-1.044), and the pooled HR for DMFS was 0.715 (95% CI: 0.023-1.407). The 95% CI of both PFS and DMFS crossed the invalid value of 1, indicating no significant statistical difference.
CONCLUSION: SUA level is an independent prognostic factor for OS in patients with NPC, and higher levels of uric acid may improve the overall survival of patients. No significant correlation was identified between SUA levels and PFS or DMFS in NPC patients. SUA may serve as a novel, convenient, and non-invasive biomarker for prognostic evaluation of NPC, may provide a reference for prognostic risk stratification and individualized management. Further large-sample, high-quality prospective cohort studies are warranted to validate the present findings.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261483250, identifier CRD420261483250.