Main characteristics of enrolled studies.

<p>Abbreviations: FFPE, formalin-fixed paraffin-embedded; AP, author provided; SC, survival curve; NM, not mentioned; OS, overall survival; DFS, disease-free survival; RFS, recurrence-free survival; TNBC, triple-negative breast cancer; Müller-b, results before therapy; Müller-a, results after therapy.</p><p>*The extracted OS data is obviously not consistent with the survival curve, so only provided RFS is used for analysis.</p><p>Main characteristics of enrolled studies.</p

Funnel plot for publication bias analysis: (A) OS; (B) DFS/RFS.

<p>Funnel plot for publication bias analysis: (A) OS; (B) DFS/RFS.</p

Forest plots of the relationship between elevated miR-21 level and OS (A) and DFS/RFS (B).

<p>Forest plots of the relationship between elevated miR-21 level and OS (A) and DFS/RFS (B).</p

Prediction of Poor Prognosis in Breast Cancer Patients Based on MicroRNA-21 Expression: A Meta-Analysis

<div><p>Background</p><p>MicroRNA-21 (miRNA-21 or miR-21) may act as a prognostic biomarker of cancer. However, the available evidence is controversial. Therefore, the present meta-analysis summarizes this evidence and evaluates the prognostic role of this gene in breast cancer.</p><p>Methods</p><p>The meta-analysis was conducted by searching the databases of PubMed, EMBASE, Web of Science and Chinese database-China National Knowledge Infrastructure (CNKI). Data were extracted from studies that investigated the association between miR-21 expression and survival outcomes in breast cancer patients. With respect to survival outcomes, the pooled hazard ratios (HRs) of miR-21 were calculated given a 95% confidence interval (CI).</p><p>Results</p><p>Our meta-analysis identified a total of 10 studies involving 1,439 cases. Further investigation demonstrated that a high miR-21 expression can predict poor overall survival (OS) (HR = 2.57, 95% CI: 1.37—4.81, <i>P</i> = 0.003) and shortened disease-free/recurrence-free survival (DFS/RFS) (HR = 1.45, 95% CI: 1.16—1.82, <i>P</i> = 0.001) in breast cancer patients. Moreover, high miR-21 expression was significantly correlated with lowered OS in the Asian group (HR = 5.07, 95% CI: 2.89—8.92, <i>P</i> < 0.001), but not in the Caucasian cohort (HR = 1.44, 95% CI: 0.99—2.10, <i>P</i> = 0.058). Furthermore, odds ratios (ORs) showed that up-regulated miR-21 levels were associated with multiple clinical characteristics.</p><p>Conclusion</p><p>Our results indicated that miR-21 can predict unfavorable prognoses in breast cancer patients, especially in Asians.</p></div

Sensitivity analysis for OS (A) and DFS/RFS (B).

<p>Sensitivity analysis for OS (A) and DFS/RFS (B).</p

Subgroup analyses of pooled hazard ratios for overall survival with elevated miR-21 expression.

<p>Subgroup analyses of pooled hazard ratios for overall survival with elevated miR-21 expression.</p

Flow diagram of the study selection process.

<p>Flow diagram of the study selection process.</p

Meta-analyses of miR-21 Expression Classified by clinicopathologic parameters.

<p>Meta-analyses of miR-21 Expression Classified by clinicopathologic parameters.</p

The Outcome of Breast Cancer Is Associated with National Human Development Index and Health System Attainment - Fig 4

<p><b>Scatter plots show the relationship between breast cancer incidence and (A) mortality, (B) MIR of countries in four different HDI categories.</b> ASR: age-standardised rate; β: standardize coefficient.</p

Differences of breast cancer MIR in four socioeconomic development levels.

<p>MIR in low, medium and high HDI countries is significantly higher than that in very high HDI countries. ***<i>P</i>< .001. Horizontal lines represent group means.</p