非小细胞肺癌p16蛋白表达与预后生存关系的Meta分析

p16 expression and its prognostic implication in non-small cell lung cancer:a meta analysis

目的评价非小细胞肺癌患者p16蛋白表达与患者预后的关系。方法采用计算机检索,按纳入和排除标准检索p16蛋白表达与非小细胞肺癌预后相关的文献,检索范围限于Cochrane图书馆、Pubmed、Medline和Embase数据库,采用Revman 4.3软件进行Meta分析,合并值为风险比(HR)。结果检索到20篇文献符合研究要求,共计1995例患者。所有非小细胞肺癌患者总生存合并HR=0.69(95%CI:0.59～0.81,P<0.05)。按病理类型、临床分期进行分层分析,肺鳞癌亚组采用固定效应模型,合并HR为0.34(95%CI:0.13～0.91,P=0.03);肺腺癌亚组和早期非小细胞肺癌亚组分别采用随机效应模型和固定效应模型,合并HR分别为0.66(95%CI:0.36～1.21,P=0.18)和0.42(95%CI:0.28～0.63,P<0.001);发表偏倚系数为0.2368(95%CI:-0.5734～1.0471)。结论 p16蛋白表达可能是非小细胞肺癌患者生存的独立预后因素,在肺鳞癌、早期肺癌亚组中也显示具有预后参考意义,在肺腺癌预后中的作用尚缺乏足够的数据支持。

Objective To evaluate the relationship between p16 protein expression and its prognostic implication in non-small cell lung cancer（NSCLC） patients.Methods All the data dealing with the the relationship between p16 expression and the prognosis of NSCLC was researched from Cochrane library,PubMed,Medline and Embase database.The outcome was measured using the hazard ratio（HR）.Data pooling was performed by RevMan 4.3.Results One thousand nine hundred and ninety-five patients from 20 studies were included in the meta-analysis.HR estimate of overall survival（OS）for patients with high level p16 expression was 0.69（95%CI：0.59-0.81,P0.05）.In patients with lung squamous carcinoma,the combined HR with fixed-effect model for OS was 0.34（95%CI：0.13-0.91,P=0.03）;Among the adenocarcinoma and the early stage of NSCLC（Ⅰ-Ⅱ）,the pooled HR for OS was 0.66（95%CI：0.36-1.21,P=0.18） and 0.42（95%CI：0.28-0.63,P0.001） respectively.Bias coefficient and its 95% confidence interval were 0.2368（-0.5734-1.0471,P=0.547）.Conclusion p16 protein expression appears to be a prognostic factor for overall survival in NSCLC patients,and also shows prognostic value in subset of lung squamous carcinoma and the early stage of NSCLC（Ⅰ-Ⅱ）,but not in lung adenocarcinoma.Additional studies with large patient number and widely accepted practical methods are required to derive the more precise outcome.