P53基因与食管鳞癌根治术预后的循证分析

An evidence-based analysis of P53 and the prognosis of radical resection of esophageal squamous cell carcinoma

目的探讨新发食管鳞癌患者P53基因表达与食管鳞癌根治术预后的关系。方法检索7个中英文数据库截止到2020年4月30日的所有相关文献(Web of science、Embase、Pubmed、Cochrane Library、中国知网、维普、万方),并筛选合格文献,采用Stata/MP软件进行循证分析,使用固定效应模型计算合并效应值及95%可信区间,使用Egger检验检测发表偏倚。结果共计29篇来自日本(16篇)、中国(10篇)、巴西(1篇)、伊朗(1篇)、德国(1篇)的高质量文献(Newcastle-Ottawa Scale,NOS≥5分)被纳入Meta分析,涵盖4652例食管鳞癌患者。P53基因与食管鳞癌根治术后随访期间总体生存率相关,其合并效应值HR=1.12(95%CI:1.01~1.22)。亚组分析显示:P53阳性表达的合并效应值HR=1.07(95%CI:0.93~1.20),其中,P53阳性表达(核染色≥10%)的总体效应值HR=1.23(95%CI:1.03~1.42),P53阳性表达(核染色>50%)的总体效应值HR=1.15(95%CI:0.77~1.53),P53高表达的合并效应值HR=1.20(95%CI:1.01~1.39),P53过表达的合并效应值HR=1.57(95%CI:1.09~2.06),P53基因突变的合并效应值HR=1.56(95%CI:0.06~3.06)。结论P53基因的高表达、阳性表达(核染色≥10%)与过表达可能与食管鳞癌根治术患者预后不良相关,可为临床预后提供参考价值,而P53基因突变的临床预后意义需要进一步深入研究。

Objective To explore the relationship of P53 gene and the prognosis of radical resection of new-onset esophageal squamous cell carcinoma(ESCC).MethodsAll the related literatures from 7 databases of Web of Science,Embase,Pubmed,Cochrane Library,CNKI,VIP and Wanfang were searched by April 30,2020.Fixed effect model was used to calculate combined hazard ratio(HR)and its 95%CI.Egger′s test was used to analyze the publishing bias.ResultsA total of 29 high-quality articles(NOS≥5 points)from Japan(16 articles),China(10 articles),Brazil(1 article),Iran(1 article)and Germany(1 article)were included in this meta-analysis,covering 4652 ESCC patients.The P53 gene was related to the overall survival during follow-up after radical resection of ESCC,and the combined effect was HR=1.12(95%CI:1.01-1.22).Furthermore,the combined effect of P53 positive expression was HR=1.07(95%CI:0.93-1.20),the overall effect value of positive expression of P53(nuclear staining≥10%)was HR=1.23(95%CI:1.03-1.42)and positive expression of P53(nuclear staining>50%)was HR=1.15(95%CI:0.77-1.53),the combined effect of P53 high expression was HR=1.20(95%CI:1.01-1.39),the combined effect of P53 over-expression was HR=1.57(95%CI:1.09-2.06)and the combined effect of P53 mutation was HR=1.56(95%CI:0.06-3.06).ConclusionsHigh and positive expression of P53 gene(nuclear staining≥10%)and over-expression may be associated with poor prognosis in patients undergoing radical resection of ESCC,which may provide reference value for clinical prognosis.However,the clinical prognostic significance of mutation of P53 gene need further researches.