Background: Resistance to chemo- and radiotherapy is the main obstacle in cancer treatment success, which results in cancer's poor prognosis. Therefore finding the exact mechanism of resistance may contribute to addressing this concern. This could result in improved cancer prognosis and survival outcomes for cancer patients by targeting the basic causes of resistance.
Aim: This systematic review and meta-analysis assessed the potential of using autophagy-related proteins as prognostic biomarkers in radiotherapy-treated patients.
Methods: Following PRISMA guidelines, we systematically reviewed 956 studies from PubMed, Scopus, and Web of Science databases until April 2023. The keywords used for this purpose were 'cancer', 'radiotherapy', 'prognosis', and 'Autophagy'. Then the related meta-analysis was performed using STATA software.
Results: Four studies met the inclusion criteria. Upregulation of autophagy markers (LC3B, Beclin1 and ULK1) and subsequent activation of autophagy were significantly associated with a higher risk of mortality (1.95 times) in radiotherapy-treated groups compared with patients with low expression of these markers. Although such results were observed for recurrence-free survival (RFS); however, it was not significant.
Conclusion: The findings of this meta-analysis suggest that autophagy activation may be a critical factor in resistance to radiotherapy and subsequent poor survival rates in cancer patients. Consequently, assessing the expression of autophagy-related markers like Beclin1, LC3II, P62, and ULK may be a useful method for monitoring cancer prognosis following radiotherapy.
Keywords: Cancer; autophagy; prognosis; radiotherapy; survival.