Association Between Telomerase Reverse Transcriptase Promoter Mutations and Melanoma Prognosis A Meta-Analysis

OBJECTIVE: The association between telomerase reverse transcriptase (TERT) promoter mutation and outcome of melanoma is unclear and controversial. We aim to conduct a meta-analysis and investigate whether the TERT promoter mutation is a prognostic factor of melanoma. STUDY DESIGN: Appropriate studies were searched in 3 databases: PubMed, Web of Science, and Embase. Pooled hazard ratios (HRs) were counted through random effects model. RESULTS: Heterogeneity was moderate in overall survival (OS) (I-2=43.7%, p=0.059) and low in disease-free survival (DFS)(I-2=0.0%, p=0.587). Sensitivity analysis indicated that the removal of any of the study did not affect the final results. Evidence for publication bias was not found (Begg's test, p=0.281; Egger's test, p=0.078). The pooled OS HRs from combined effects analysis was determined (HR 1.07; 95% CI 0.83-1.39, p=0.585), together with the pooled HRs of DFS (HR 1.65; 95% CI 1.02-2.66, p=0.042). TERT promoter mutation predicted a good outcome in meta-static melanoma patients (HR 0.66; 95% CI 0.46-0.96, p=0.042). The pooled HRs of combined mutation in TERT promoter and BRAF (HR 6.27; 95% CI 2.7-14.58, p=0.000) predicted a bad outcome in melanoma patients. CONCLUSION: TERT promoter mutation significantly predicted poor DFS outcome but, on the contrary, predicted a good outcome in metastatic melanoma patients. The combined TERT promoter and BRAF mutation was a significant independent factor of OS in melanoma patients.