title: Predictive value of thymidylate synthase expression in gastric cancer: a systematic review with meta-analysis.
abstract: OBJECTIVE
  The relationship between thymidylate synthase (TS) expression and outcomes in gastric cancer (GC) patients remains controversial, although most studies reported poor survival and reduced response to fluoropyrimidine were related to high TS in tumors. We carried out a systematic review of the literature with meta-analysis to estimate the predictive value of TS expression from published studies.
  
  
  METHODS
  We identified 24 studies analysing the outcome data in gastric cancer stratified by TS expression. Effect measures of outcome were hazard ratios (HRs) for overall survival (OS) and event-free survival (EFS), or the odds ratio (OR) for overall response rate (ORR). HRs and ORs from these eligible studies were pooled using random-effects meta- analysis.
  
  
  RESULTS
  Fifteen studies investigated outcomes in a total of 844 patients with advanced GC, and nine studies investigated outcomes in a total of 1,235 patients with localized GC undergoing adjuvant therapy. Meta- analysis of estimates showed high TS expression was significantly associated with poor OS in the advanced setting (HR: 1.43, 95%CI: 1.08 - 1.90), and poor EFS in the adjuvant setting (HR: 1.53, 95%CI: 1.01 - 2.32). Subgroup analysis demonstrated TS expression to have even greater value in predicting OS, EFS and ORR in advanced GC patients treated with fluoropyrimidine monotherapy (HR for OS: 2.32, 95%CI: 1.53 - 3.50; HR for EFS: 1.76, 95%CI: 1.19 - 2.60; OR for ORR: 0.32, 95%CI: 0.11 - 0.95).
  
  
  CONCLUSIONS
  High levels of TS expression were associated with a poorer OS for advanced GC patients compared with low levels. In the adjuvant setting, high TS expression was also associated with a worse EFS. Additional studies with consistent methodology are needed to define the precise predictive value of TS.
authors.affiliation: Department of Oncology, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Hua-Bin
authors.initials: HB
authors.lastname: Hu
authors.forename: Lei
authors.initials: L
authors.lastname: Kuang
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Zeng
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.forename: En-Yi
authors.initials: EY
authors.lastname: Liu
authors.forename: Mei-Zuo
authors.initials: MZ
authors.lastname: Zhong
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D015201:Meta-Analysis as Topic; D011379:Prognosis; D013274:Stomach Neoplasms / Q000201:enzymology* / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D013940:Thymidylate Synthase / Q000378:metabolism*
chemical_list: D013940:Thymidylate Synthase