Elevated YKL-40 expression is associated with a poor prognosis in breast cancer patients

// Guoxing Wan 1, * , Longchao Xiang 2, 3, * , Xue Sun 1, * , Xuanbin Wang 2, 3 , Hongliang Li 2, 3 , Wei Ge 4 , Fengjun Cao 1 1 Department of Oncology, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China 2 Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, Shiyan 442000, Hubei, China 3 Laboratory of Chinese Herbal Pharmacology, Oncology Center, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China 4 Department of Oncology, Renmin Hospital, Wuhan University, Wuhan 430060, Hubei, China * These authors have contributed equally to this work Correspondence to: Fengjun Cao, email: fengjuncaoshiyan@126.com Wei Ge, email: gewei514@126.com Keywords: YKL-40, breast cancer, prognosis, meta-analysis Received: August 01, 2016 Accepted: December 07, 2016 Published: December 27, 2016 ABSTRACT Numerous studies have investigated the prognostic role of YKL-40 in breast cancer, but yielded inconsistent results. To derive a more precise evaluation, relevant publications assessing the association between YKL-40 expression and clinical outcome of breast cancer patients were electronically searched and identified. A combined analysis of included studies was performed using fixed- or random-effect model to calculate the pooled hazard ratio (HR) or odds ratio(OR) and 95% confidence interval (95%CI) for the assessment of the association. Ten eligible studies involving 1250 patients were ultimately included in the meta-analysis. Overall, the pooled analysis showed that elevated YKL-40 expression was significantly associated with a poor overall survival(OS: HR=1.48, 95%CI= 1.11-1.97) and disease-free survival(DFS: HR=1.51, 95%CI= 1.10-2.07). The subgroup analysis by detection methods revealed an unfavorable OS in breast cancer patients with elevated YKL-40 expression evaluated by IHC(HR=1.39, 95%CI=1.12-1.71) but not by ELISA/RIA. Also, the stratification analysis by ethnicity showed a significant association between increased YKL-40 expression and shorter OS of breast cancer patients in western population(HR=1.51, 95%CI=1.03-2.21) as well as Asian population (HR=1.40, 95%CI= 1.05-1.86). Similarly, the subgroup analysis by detection methods revealed a significantly inferior DFS in breast cancer patients with increased YKL-40 expression disregarding the use of IHC(HR=2.02, 95%CI=1.47-2.79) or ELISA/RIA(HR=1.06, 95%CI= 1.02 -1.10). Additionally, increased YKL-40 expression was found to significantly correlate with larger tumor size (OR=2.38, 95%CI=1.41-4.05).The present meta-analysis indicate that elevated YKL-40 expression is associated with a poor prognosis in breast cancer patients. YKL-40 may serve as a promising predictive biomarker of prognosis of breast cancer.