Prognostic value of circular RNAs expression and their correlation with clinicopathological features in acute myeloid leukemia: a systematic review and meta-analysis.

Acute myeloid leukemia (AML) prognosis is affected by unique factors to each individual and studies have indicated that dysregulated expression of circRNAs may serve as prognostic biomarkers for AML. Therefore, we conducted this study to assess the prognostic value of circRNAs expression and it's correlation with clinicopathological features. Comprehensive search was conducted in WOS, Scopus, PubMed, Google Scholar, ProQuest, and grey literature. The certainty of evidence was assessed using the modified GRADE approach for prognostic and clinicopathological meta-analysis. The hazard ratio (HR) was employed to assess the prognostic value of dysregulated expression of circRNAs in patient survival, while the risk ratio (RR) was utilized to analyze the correlation between circRNAs and clinicopathological features. Our results demonstrated that dysregulation of circRNAs expression was associated with poor prognosis related to overall survival (OS) indicator (HR:2.05; 95%CI: 1.75-2.40) and also related to non-OS indicators such as (EFS, LFS, RFS, and DFS) (HR:2.09, 95%CI: 1.47-2.97). Priori and post-hoc subgroup analysis was conducted to describe variables that potentially affected heterogeneity and effect size. We also evaluated the association between dysregulated expression of circRNAs and 19 clinicopathological parameters. Our results show that there is significant relationship between the dysregulated expression of circRNAs and the mentioned parameters: type M6 vs. other types (RR:1.51, 95% CI:1.12-2.03), FLT3-ITD mutation (RR:1.17, 95%CI: 1.00-1.36), and risk status (RR:1.35, 95% CI: 1.13-1.60). This systematic review and meta-analysis suggest that the investigation of circRNAs expression changes can serve as valuable biomarkers for the assessment of prognosis in AML patients.