雌激素受体α与食管鳞状细胞癌预后关系的Meta分析

Relationship between estrogen receptor alpha and prognosis of patients with esophageal squamous cell carcinoma: a Meta-analysis

目的采用Meta分析评价雌激素受体α(ERα)在食管鳞状细胞癌(ESCC)中的表达及其与ESCC患者预后的关系。方法依据制定的检索策略,在PubMed、Embase、CNKI、万方数据库检索从建库至2018年2月公开发表的相关文献。采用纽卡斯尔-渥太华量表(NOS)评价纳入文献的质量。分析患者总生存率(OS),分别以风险比(HR)和95%可信区间(CI)表示检验效应量和检验水准。采用RevMan 5.0、STATA 12.0软件进行统计分析,Begg秩相关法和Egger回归法评估纳入文献的发表偏倚。结果共纳入5篇回顾性队列分析文献,共1018例病例。文献质量评价较好且无发表偏倚。Meta分析结果显示ERα阳性表达的ESCC患者OS低(HR=1.69,95%CI=1.31~2.18)。依据研究人群来源进行亚组分析结果提示ERα阳性表达与中国ESCC患者术后OS有关(HR=1.69,95%CI=1.26~2.28),与日本ESCC患者术后OS无关(HR=1.73,95%CI=0.67~4.44)。ERα阳性表达与肿瘤分化程度有关,与高分化ESCC相比,低分化/未分化ESCC中ERα阳性表达率明显增高(79.3%vs 58.5%)。未发现ERα表达与肿瘤浸润深度、淋巴结转移及TNM分期的关系。结论ERα蛋白可作为中国ESCC患者预后不良的分子检测指标,且ERα高表达与ESCC低分化/未分化有关。

Objective Meta-analysis was used for evaluation the expression of estrogen receptor alpha(ERα)in patients with esophageal squamous cell carcinoma(ESCC)and the relationship with their prognosis.Method According to the detailed search strategies,relevant studies were screened from PubMed,Embase,CNKI and Wanfang databases(from the start date to February,2018).Newcastle-Ottawa scale(NOS)was used to assess the quality of the eligible literatures.Patients’overall survival(OS)with hazard ratio(HR)and 95%confidence interval(CI)were employed as the test effect indexes.The statistical analysis was conducted by the RevMan 5.0 and STATA 12.0 software and the publication bias was assessed by Begg’s and Egger’s test.Result A total of 5 literatures of retrospective cohort analysis containing 1018 patients were finally included in the analysis.All studies were with acceptable quality and no publication bias.The Metaanalysis results testified that ERαpositive expression was associated with poor OS among ESCC patients(HR=1.69,95%CI=1.31-2.18).The subgroup analysis,stratified by geographic area,showed that ERαpositive expression was associated with postoperative OS in Chinese ESCC patients(HR=1.69,95%CI=1.26-2.28),while was independent with the OS among Japanese ESCC patients(HR=1.73,95%CI=0.67-4.44).The positive expression rate of ERαwas significantly associated with tumor differentiation,and it was significantly increased in poorly differentiated or undifferentiated ESCC(79.3%)as compared to highly differentiated ESCC(58.5%).No correlations were found between ERαexpression and tumor invasion depth,lymph node metastasis and TNM stage.Conclusion ERαprotein may become the molecular biomarker for poor prognosis in Chinese ESCC patients,and high expression of ERαis correlated with poor differentiation or undifferentiation of ESCC.