中国循证医学杂志

中国循证医学杂志

血浆纤维蛋白表达水平与肾细胞癌风险相关性的 Meta 分析

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目的 系统评价血浆纤维蛋白原表达水平与肾细胞癌患者临床病理特点及预后的相关性。 方法 计算机检索 PubMed、EMbase、The Cochrane Library(2016 年 5 期)、CNKI、CBM 和 WanFang Data 数据库,搜集血浆纤维蛋白原表达水平与肾癌风险相关性的队列研究,检索时限均为建库至 2016 年 5 月。由 2 名研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用 RevMan 5.3 软件对数据进行 Meta 分析。 结果 共纳入 7 个队列研究,共 3 744 例患者。Meta 分析结果显示:血浆纤维蛋白原低表达组的肾细胞癌患者在总生存率[HR=2.13,95%CI(1.74,2.61),P<0.000 01]、肿瘤特异性生存率[HR=3.12,95%CI(2.19,4.44),P<0.000 01]方面均显著高于高表达组。亚组分析结果显示,血浆纤维蛋白原的表达水平在 TNM 临床分期Ⅲ~Ⅳ期明显高于Ⅰ~Ⅱ期[OR=0.27,95%CI(0.13,0.55),P=0.000 3],在 Fuhrman 病理分级 G3+G4 期明显高于 G1+G2 期[OR=0.49,95%CI(0.40,0.59),P<0.000 01],且差异均有统计学意义;但表达水平在性别上无差异[OR=0.85,95%CI(0.69,1.05),P=0.14]。 结论 现有证据表明,血浆纤维蛋白原的表达水平与肾细胞癌患者临床病理和预后具有明显相关性。受纳入研究数量和质量的限制,以上结论仍需进一步开展更多高质量的研究加以验证。

Objective To systematically review the prognostic and clinicopathological value of plasma fibrinogen in renal cell carcinoma (RCC). Methods An electronic search of the PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, CBM and WanFang Data databases was performed to collect cohort studies about the prognostic value of plasma fibrinogen in RCC from inception to May 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of 3 744 RCC patients from 7 cohort studies were included. The results of meta-analysis showed that the lower plasma fibrinogen expression group was superior to the higher expression group in overall survival (HR=2.13, 95%CI 1.74 to 2.61,P<0.00 001) and cancer-specific survival (HR=3.12, 95%CI 2.19 to 4.44,P<0.00 001). Subgroup analysis showed that plasma fibrinogen expression was higher in stage Ⅲ to Ⅳ than stage ⅠtoⅡ (OR=0.27, 95%CI 0.13 to 0.55,P=0.000 3) and was higher in Fuhrman grading G3+G4 than grading G1+G2 (OR=0.49, 95%CI 0.40 to 0.59,P<0.000 01). However, the level of plasma fibrinogen was not found to be associated with gender (OR=0.85, 95%CI 0.69 to 1.05,P=0.14). Conclusion Current evidence shows plasma fibrinogen expression is associated with the prognostic and clinicopathological value of RCC. Due to limited quantity and quality of included studies, the above conclusions are still needed to be verified by more high quality studies.

关键词: 血浆纤维蛋白原; 肾细胞癌; Meta 分析; 队列研究

Key words: Plasma fibrinogen; Renal cell carcinoma; Meta-analysis; Cohort study

引用本文: 胥芸芸, 翟振兴, 李桂香. 血浆纤维蛋白表达水平与肾细胞癌风险相关性的 Meta 分析. 中国循证医学杂志, 2017, 17(5): 529-535. doi: 10.7507/1672-2531.201606076 复制

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