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Article Open Access

Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis

  • Authors:
    • Abdulla Alzibdeh
    • Ala'a Khanfar
    • Maysa Al-Hussaini
    • Ramiz Abuhijlih
    • Issa Mohamad
    • Hikmat Abdel-razeq
    • Fawzi Abuhijla
  • View Affiliations / Copyright

    Affiliations: Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan, Department of Pathology, King Hussein Cancer Center, Amman 11941, Jordan, Department of Medical Oncology, King Hussein Cancer Center, Amman 11941, Jordan
    Copyright: © Alzibdeh et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 53
    |
    Published online on: December 15, 2025
       https://doi.org/10.3892/etm.2025.13048
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Abstract

O6‑methylguanine‑DNA methyltransferase (MGMT) serves a crucial role in DNA repair by removing alkyl lesions from the O6 position of guanine, maintaining genomic stability. Loss of MGMT expression, often due to promoter methylation, is linked to enhanced sensitivity to chemotherapy. While MGMT methylation has been observed in various cancers, its impact on overall survival (OS) in solid tumors remains uncertain. According to the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses guidelines, studies were selected from PubMed that examined the impact of MGMT methylation on OS in adult patients with solid tumors. Data were extracted where methylation status was defined, and OS was reported through hazard ratios (HRs) and confidence intervals (CIs) from either univariate or multivariable analyses. R version 4.4.2 and the ‘meta’ package were employed for the meta‑analysis, using both fixed‑effects (Mantel‑Haenszel method) and random‑effects (DerSimonian‑Laird method with Hartung‑Knapp adjustment) models based on the I2 statistic for heterogeneity. Subgroup analyses were performed by cancer type, and publication bias was assessed through funnel plot inspection and Egger's regression. A total of 21 studies involving 2,946 patients met the inclusion criteria. The fixed‑effects model showed a significant association between MGMT promoter methylation and poorer OS (HR=1.27; 95% CI, 1.13‑1.42; P<0.0001); however, notable heterogeneity (I²=64.7%) led to a non‑significant result under the random‑effects model (HR=1.26; 95% CI, 0.97‑1.65; P=0.084). Subgroup analyses revealed that MGMT methylation was strongly associated with decreased survival in biliary tract (HR=2.31), cervical (HR=2.50) and duodenal cancers (HR=4.25), whereas melanoma exhibited improved survival (HR=0.32). Other cancer types, including colorectal, esophageal, head and neck, leiomyosarcoma, non‑small cell lung cancer and pancreatic neuroendocrine tumors, demonstrated no notable relationship between MGMT methylation and OS. Sensitivity analyses confirmed the stability of these findings despite the inherent heterogeneity. In conclusion, MGMT promoter methylation may be a prognostic biomarker in select solid tumors; however, its impact on OS varies by cancer type. Further studies with standardized methylation assessment methods are warranted to clarify its prognostic and predictive utility, especially on OS.
View Figures

Figure 1

Study selection flow diagram. The
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
flow diagram illustrates the study selection process.

Figure 2

Forest plot of MGMT promoter
methylation and OS. The forest plot displays individual HRs with
corresponding 95% CIs for the association between MGMT promoter
methylation and OS across the included studies. Both fixed-effects
and random-effects model estimates are presented, along with
heterogeneity statistics. OS, overall survival; CI, confidence
intervals; HR, hazard ratio; MGMT, O6-methylguanine-DNA
methyltransferase.

Figure 3

Histogram-style summary of the pooled
HRs for OS associated with MGMT promoter methylation across
different solid tumor types. Bars represent pooled HR for each
cancer type with horizontal lines indicating 95% CIs. The vertical
dashed line (HR=1) represents the null reference line (no effect).
Orange bars indicate a significant association with worse OS
(HR>1), blue bars indicate a significant association with
improved OS (HR<1) and gray bars represent non-significant
associations where the 95% CI includes 1. The plot uses a
logarithmic x-axis to facilitate comparison across cancer types
with differing effect magnitudes. HR, hazard ratio; CI, confidence
interval; OS, overall survival; NSCLC, non-small cell lung cancer;
NET, neuroendocrine tumor; MGMT, O6-methylguanine-DNA
methyltransferase.

Figure 4

Funnel plot assessing publication
bias. This funnel plot examines the potential for publication bias
among the included studies. It shows the distribution of study
effect sizes relative to their standard errors. The symmetrical
distribution observed, alongside the non-significant Egger's test
(P=0.895), suggests no substantial publication bias. HR, hazard
ratio; MGMT, O6-methylguanine-DNA methyltransferase.

Figure 5

Sensitivity analysis. The sensitivity
analysis was performed using the leave-one-out approach, and the
figure demonstrates the robustness of the pooled HR by sequentially
excluding each study. The analysis confirms that the overall effect
estimate remains stable (HR range: 1.20-1.33) and that no single
study disproportionately influences the results, despite moderate
heterogeneity. The pooled estimate is based on a random-effects
model with HK adjustment. HR, hazard ratio; CI, confidence
interval; HK, Hartung-Knapp.
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Copy and paste a formatted citation
Spandidos Publications style
Alzibdeh A, Khanfar A, Al-Hussaini M, Abuhijlih R, Mohamad I, Abdel-razeq H and Abuhijla F: Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis. Exp Ther Med 31: 53, 2026.
APA
Alzibdeh, A., Khanfar, A., Al-Hussaini, M., Abuhijlih, R., Mohamad, I., Abdel-razeq, H., & Abuhijla, F. (2026). Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis. Experimental and Therapeutic Medicine, 31, 53. https://doi.org/10.3892/etm.2025.13048
MLA
Alzibdeh, A., Khanfar, A., Al-Hussaini, M., Abuhijlih, R., Mohamad, I., Abdel-razeq, H., Abuhijla, F."Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis". Experimental and Therapeutic Medicine 31.2 (2026): 53.
Chicago
Alzibdeh, A., Khanfar, A., Al-Hussaini, M., Abuhijlih, R., Mohamad, I., Abdel-razeq, H., Abuhijla, F."Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis". Experimental and Therapeutic Medicine 31, no. 2 (2026): 53. https://doi.org/10.3892/etm.2025.13048
Copy and paste a formatted citation
x
Spandidos Publications style
Alzibdeh A, Khanfar A, Al-Hussaini M, Abuhijlih R, Mohamad I, Abdel-razeq H and Abuhijla F: Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis. Exp Ther Med 31: 53, 2026.
APA
Alzibdeh, A., Khanfar, A., Al-Hussaini, M., Abuhijlih, R., Mohamad, I., Abdel-razeq, H., & Abuhijla, F. (2026). Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis. Experimental and Therapeutic Medicine, 31, 53. https://doi.org/10.3892/etm.2025.13048
MLA
Alzibdeh, A., Khanfar, A., Al-Hussaini, M., Abuhijlih, R., Mohamad, I., Abdel-razeq, H., Abuhijla, F."Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis". Experimental and Therapeutic Medicine 31.2 (2026): 53.
Chicago
Alzibdeh, A., Khanfar, A., Al-Hussaini, M., Abuhijlih, R., Mohamad, I., Abdel-razeq, H., Abuhijla, F."Impact of MGMT methylation on overall survival in solid tumors: A systematic review and meta‑analysis". Experimental and Therapeutic Medicine 31, no. 2 (2026): 53. https://doi.org/10.3892/etm.2025.13048
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