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目的系统评价孕激素受体(progesterone receptor,PR)的表达与卵巢癌患者预后的相关性。方法计算机检索PubMed、EMbase、MEDLINE、The Cochrane Library(2016年1期)、CNKI、VIP、CBM和WanFang Data数据库中有关PR表达与卵巢癌预后相关的队列研究,检索时限均从建库至2016年6月1日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入12个研究,包括1 881例患者。Meta分析结果显示,PR阳性表达患者的总生存率[HR=0.64,95%CI(0.44,0.93),P=0.02]、无病生存期[HR=0.64,95%CI(0.48,0.85),P=0.002]和无进展生存期[HR=0.62,95%CI(0.47,0.82),P=0.000 9]均长于PR阴性表达患者;PR阳性表达患者化疗后的缓解率明显高于PR阴性表达患者[OR=1.91,95%CI(1.28,2.86),P=0.002],其差异均有统计学意义。按临床病理特征比较分析:卵巢癌Ⅰ~Ⅱ期PR表达水平高于Ⅲ~Ⅳ期[OR=2.38,95%CI(1.71,3.32),P<0.000 01],G1~G2组高于G3组[OR=2.48,95%CI(1.72,3.56),P<0.000 01],但浆液性卵巢癌与非浆液性卵巢癌与PR表达不存在相关性[OR=1.28,95%CI(0.89,1.83),P=0.18]。结论当前证据表明PR蛋白表达与卵巢癌的预后具有相关性。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究予以验证。
Objective To evaluate the relationship between the expression of progesterone receptor (PR) and the prognosis of patients with ovarian cancer. Methods The cohort study on PR expression and prognosis of ovarian cancer in PubMed, EMbase, MEDLINE, The Cochrane Library (2016 1), CNKI, VIP, CBM and WanFang Data was searched by computer. June 1. After two independent reviewers screened the literature, extracted data and assessed the risk of being included in the study, Meta-analysis was performed using RevMan 5.3 software. Results A total of 12 studies were included, including 1,881 patients. Meta-analysis showed that the overall survival rate of patients with positive expression of PR [HR = 0.64,95% CI (0.44,0.93), P = 0.02], disease-free survival [HR = 0.64,95% CI P = 0.002], and progression-free survival [HR = 0.62,95% CI (0.47,0.82), P = 0.0009] were longer in PR-negative patients than those in PR-positive patients Patients [OR = 1.91, 95% CI (1.28, 2.86), P = 0.002], the differences were statistically significant. According to the clinicopathological characteristics, the expression of PR in stage Ⅰ ~ Ⅱ ovarian cancer was higher than that in stage Ⅲ ~ Ⅳ [OR = 2.38,95% CI (1.71,3.32, P <0.000 01] (OR = 2.48, 95% CI, 1.72, 3.56, P <0.000 01). However, there was no correlation between serous ovarian cancer and non-serous ovarian cancer and PR expression [OR = 1.28,95% CI ), P = 0.18]. Conclusions Current evidence suggests that PR protein expression is associated with the prognosis of ovarian cancer. Subject to the limitations of the quantity and quality of the research, the above conclusion still needs more high-quality research to be verified.