Growth Differentiation Factor-15 as a candidate biomarker in gynecologic malignancies: A meta-analysis

Abstract

<jats:p>Introduction: Growth Differentiation Factor-15 (GDF-15) has emerged as a novel marker in gynecological cancers. But its suitability in clinical diagnostics is yet to be recognized. Materials and methods: We sorted out eligible studies from multiple online databases like Pubmed, Cochrane, ClinicalTrials.gov, Google Scholar, Web of Science, Embase, Scopus, LILACS, and Opengrey. The terms used were 'Growth Differentiation Factor-15', 'GDF-15', 'Macrophage Inhibitory Cytokine-1', 'MIC-1', 'Ovarian cancer', 'Ovarian carcinoma', 'Endometrial cancer', 'Endometrial carcinoma', 'Uterine cancer', 'Uterine Carcinoma', 'Cervical cancer', 'Cervical carcinoma', 'diagnosis', 'sensitivity', 'specificity', 'prognosis', and 'outcome'. Of the full-text, potentially eligible records, six were found eligible for inclusion into our meta-analysis. Studies were selected only if the diagnosis was proven by pathology, cases recruited were those without any prior treatment, sufficient diagnostic accuracy data were present for GDF-15 in gynecological cancers, and ethical approval was taken from Institutional Ethics Committee. Nonclinical research and animal studies were excluded. We took the assistance of the Rayyan QCRI software for the screening and selection process. We conducted the study following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and used Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) to assess the risk of bias. The protocol was registered at PROSPERO, registration number CRD42019130097. Results: We extracted diagnostic accuracy data from the articles and evaluated the role of GDF-15 by pooling the sensitivity, specificity, and diagnostic odds ratio (DOR) and plotting a summary receiver operating characteristic (SROC) curve. Since there was heterogeneity across the studies, the random-effects model was employed to carry out the integration. The meta-analysis showed that GDF-15 has a pooled DOR of 12.74 at 80.5% sensitivity and 74.1% specificity, with an area under the curve (AUC) of 0.84. Conclusion: Our analysis suggests that GDF-15 may be a useful candidate marker to differentiate malignant from non-malignant tumors of the female reproductive system.</jats:p>

Growth Differentiation Factor-15, High-Sensitivity Cardiac Troponin T, and N-Terminal pro-B-type Natriuretic Peptide for Predicting Risk of Venous Thromboembolism in Ambulatory Cancer Patients Receiving Chemotherapy

“…Our results were limited to patients with intermediate to high risk for VTE (Khorana score 2) with biomarker levels obtained at 1 month after start of chemotherapy. In addition, GDF-15, NT-proBNP, and hs-TnT could be correlated with other VTE risk factors such as stage of cancer, presence of metastasis, heart disease, and renal failure, 32,40,41,[46][47][48][49] these were unaccounted for in the models due to the small sample size and low event rate, which could have led to residual confounding. Moreover, biomarker levels might have been influenced by cancer therapy, especially that these biomarkers are markers of oxidative stress, cardiac dysfunction, and/or cardiotoxicity, 21,24,25,43 which are common cardiovascular adverse effects from chemotherapeutic agents.…”

“…failure, 32,40,41,[46][47][48][49] that were unaccounted for in the models due to the small sample size and low event rate, which could have led to residual confounding. Moreover, biomarker levels might have been influenced by cancer therapy, especially that these biomarkers are markers of oxidative stress, cardiac dysfunction and/or cardiotoxicity 21,24,25,43 which are common cardiovascular adverse effects from chemotherapeutic agents.…”

Is Serum Creatine Phosphokinase Level Useful to Predict the Severity of Organophosphate Poisoning?

“…Moreover, our study is based on a group of patients encountered in a single tertiary care center in Eastern India; therefore, the efficacy and reliability of CPK need to be tested in other ethnic groups, and proper cut-off values must be determined and internationally validated in cases where it can be utilized as a candidate marker. 29…”