long-chain family member 4 (ACSL4) on the prognosis of patients with liver cancer. Methods

Systematic searches were conducted in PubMed, Embase, Cochrane Library, Web of Science,

CNKI, Wanfang Medical and VIP databases from inception to February 2023 to collect cohort

studies that explored the impact of ACSL4 expression on the prognosis of patients with

liver cancer. The literature screening was performed independently by two evaluators. The

quality of eligible studies were evaluated according to the Newcastle Ottawa Scale (NOS)

and relevant data including clinical and pathological characteristics of liver cancer patients,

outcome indicators and HR (95%CI) of the study etc. were extracted. Statistical analysis of

data from the literature was performed using stata 17.0 software. The risk of bias was assessed using funnel plots and Egger’s test. Results Six cohort trials with a total of 890 liver cancer

patients were included. Meta-analysis showed that liver cancer patients with an increased

ACSL4 expression had shorter overall survival (OS) (HR = 1.274, 95%CI: 1.141～1.422,

P ＜ 0.001). The ACSL4 expression in male patients with liver cancer was higher than those

in female patients (OR = 1.12, 95%CI: 1.008～1.224, P ＜ 0.05). Egger’s test showed that

the likelihood of publication bias between studies was small and not statistically significant

(P = 0.055). Besides, age, tumor stage, tumor size, tumor envelope integrity and appearance

of cirrhosis were not significantly correlated with the expression level of ACSL4 (all P ＞ 0.05).

Conclusions High ACSL4 expression was significantly associated with shorter OS in patients

with liver cancer, more high-quality clinical studies were needed to validate this conclusion.