首页膀胱肿瘤治疗及预后证据详情

透明质酸诊断膀胱癌准确性的 Meta 分析

原文: 2016 年 发布于 Medicine 浏览量:157次

作者: 王骏臣 张煦

作者单位: Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria. Men's Health and Reproductive Health Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. Department of Urology, King Faisal Medical City, Abha, Saudi Arabia. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Department of Urology, University Hospital Zurich, Zurich, Switzerland. Research Centre for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Department of Urology, University Hospital of Tours, Tours, France. Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia. Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada. S.H.Ho Urology, Department of Surgery, Chinese University of Hong Kong, Hong Kong, China. Department of Urology, Weill Cornell Medical College, New York, NY, USA. Department of Urology, University of Texas Southwestern, Dallas, TX, USA. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. Division of Urology, Department of Special Surgery, Jordan University Hospital, University of Jordan, Amman, Jordan. European Association of Urology Research Foundation, Arnhem, the Netherlands.

归属分类: 膀胱肿瘤治疗及预后证据

DOI: 10.3390/cancers14102545

文献简介

Ki-67 is considered as one of prime biomarkers to reflect cell proliferation and immunohistochemical Ki-67 staining has been widely applied in clinical pathology. To solve the widespread controversy whether Ki-67 reactivity significantly predicts clinical prognosis of bladder carcinoma (BC), we performed a comprehensive meta-analysis by combining results from different literature. A comprehensive search was conducted in the Chinese databases of WanFang, China National Knowledge Infrastructure and Chinese VIP as well as English databases of PubMed, ISI web of science, EMBASE, Science Direct, and Wiley online library. Independent studies linking Ki-67 to cancer-specific survival (CSS), disease-free survival (DFS), overall survival (OS), progression-free survival (PFS), and recurrence-free survival (RFS) were included in our meta-analysis. With the cut-off values literature provided, hazard ratio (HR) values between the survival distributions were extracted and later combined with STATA 12.0. In total, 76 studies (n = 13,053 patients) were eligible for the meta-analysis. It was indicated in either univariate or multivariate analysis for survival that high Ki-67 reactivity significantly predicted poor prognosis. In the univariate analysis, the combined HR for CSS, DFS, OS, PFS, and RFS were 2.588 (95% confidence interval [CI]: 1.623-4.127, P < 0.001), 2.697 (95%CI: 1.874-3.883, P < 0.001), 2.649 (95%CI: 1.632-4.300, P < 0.001), 3.506 (95%CI: 2.231-5.508, P < 0.001), and 1.792 (95%CI: 1.409-2.279, P < 0.001), respectively. The pooled HR of multivariate analysis for CSS, DFS, OS, PFS, and RFS were 1.868 (95%CI: 1.343-2.597, P < 0.001), 2.626 (95%CI: 2.089-3.301, P < 0.001), 1.104 (95%CI: 1.008-1.209, P = 0.032), 1.518 (95%CI: 1.299-1.773, P < 0.001), and 1.294 (95%CI: 1.203-1.392, P < 0.001), respectively. Subgroup analysis of univariate analysis by origin showed that Ki-67 reactivity significantly correlated with all 5 clinical outcome in Asian and European-American patients (P < 0.05). For multivariate analysis, however, the pooled results were only significant for DFS, OS, and RFS in Asian patients, for CSS, DFS, PFS, and RFS in European-American patients (P < 0.05). In the subgroup with low cut-off value (<20%), our meta-analysis indicated that high Ki-67 reactivity was significantly correlated with worsened CSS, DFS, OS, PFS, and RFS on univariate analysis (P < 0.05). For multivariate analysis, the meta-analysis of literature with low cut-off value (<20%) demonstrated that high Ki-67 reactivity predicted shorter DFS, PFS, and RFS in BC patients (P < 0.05). In the subgroup analysis of high cut-off value (≥20%), our meta-analysis indicated that high Ki-67 reactivity, in either univariate or multivariate analysis, significantly correlated with all five clinical outcomes in BC patients (P < 0.05). The meta-analysis indicates that high Ki-67 reactivity significantly correlates with deteriorated clinical outcomes in BC patients and that Ki-67 can be considered as an independent indicator for the prognosis by the meta-analyses of multivariate analysis.

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