中国循证医学杂志

中国循证医学杂志

孕激素受体的表达与卵巢癌预后相关性的 Meta 分析

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目的 系统评价孕激素受体(progesterone receptor,PR)的表达与卵巢癌患者预后的相关性。 方法 计算机检索 PubMed、EMbase、MEDLINE、The Cochrane Library(2016 年 1 期)、CNKI、VIP、CBM 和 WanFang Data 数据库中有关 PR 表达与卵巢癌预后相关的队列研究,检索时限均从建库至 2016 年 6 月 1 日。由 2 位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 共纳入 12 个研究,包括 1 881 例患者。Meta 分析结果显示,PR 阳性表达患者的总生存率[HR=0.64,95%CI(0.44,0.93),P=0.02]、无病生存期[HR=0.64,95%CI(0.48,0.85),P=0.002]和无进展生存期[HR=0.62,95%CI(0.47,0.82),P=0.000 9]均长于 PR 阴性表达患者;PR 阳性表达患者化疗后的缓解率明显高于 PR 阴性表达患者[OR=1.91,95%CI(1.28,2.86),P=0.002],其差异均有统计学意义。按临床病理特征比较分析:卵巢癌Ⅰ~Ⅱ期 PR 表达水平高于Ⅲ~Ⅳ期[OR=2.38,95%CI(1.71,3.32),P<0.000 01],G1~G2 组高于 G3 组[OR=2.48,95%CI(1.72,3.56),P<0.000 01],但浆液性卵巢癌与非浆液性卵巢癌与 PR 表达不存在相关性[OR=1.28,95%CI(0.89,1.83),P=0.18]。 结论 当前证据表明 PR 蛋白表达与卵巢癌的预后具有相关性。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究予以验证。

Objective To systematically review the prognostic value of progesterone receptor (PR) for survival in ovarian cancer. Methods PubMed, EMbase, MEDLINE, The Cochrane Library (Issue 1, 2016), CNKI, VIP, CBM and WanFang Data databases were searched for cohort studies on the correlation between PR expression and prognosis of ovarian cancer from inception to June 1st 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 studies involving 1 881 patients were included. The results of meta-analysis showed that the PR positive patients was superior than the PR negative patients on overall survival (OS) (HR=0.64, 95%CI 0.44 to 0.93,P=0.02), disease free survival (DFS) (HR=0.64, 95%CI 0.48 to 0.85,P=0.002), progression free survival (PFS) (HR=0.62, 95%CI 0.47 to 0.82,P=0.000 9) and remission rate of chemotherapy (OR=1.91, 95%CI 1.28 to 2.86,P=0.002). When analysis based on the clinical pathogesis stages, PR expression was higher in clinical stages Ⅰ-Ⅱ than stage Ⅲ-Ⅳ (OR=2.38, 95%CI 1.71 to 3.32,P<0.000 01), and was higher in cell differentiation G1-G2 than G3 (OR=2.48, 95%CI 1.72 to 3.56,P<0.000 01), while no significant difference was found in groups of serous ovarian cancervs. non serous ovarian cancer (OR=1.28, 95%CI 0.89 to 1.83,P=0.18). Conclusion The current evidence shows that the expression of PR protein have predictive value for the prognosis of ovarian cancer. Due to limited quantity and quality of included studies, the above conclusions are still needed to verified by more high quality studies.

关键词: 卵巢癌; 孕激素受体; 预后因素; Meta 分析

Key words: Ovrian cancer; Progesterone receptor; Prognostic factor; Meta-analysis

引用本文: 董晓莉, 郑洪. 孕激素受体的表达与卵巢癌预后相关性的 Meta 分析. 中国循证医学杂志, 2017, 17(3): 327-333. doi: 10.7507/1672-2531.201608021 复制

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