Department of Otolaryngology/Head and Neck Surgery, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
Cancer Epidemiol Biomarkers Prev. 2010 Feb;19(2):574-87. doi: 10.1158/1055-9965.EPI-09-0981.
To summarize existing evidence about whether the presence of mutant or upregulated p53 is a prognostic factor for patients presenting with squamous cell carcinoma arising from the larynx, oropharynx, hypopharynx, or oral cavity.
Relevant articles were identified using strict criteria for systematic searches. Associations between mutant or upregulated p53 versus wild-type or low/undetectable p53 in relation to overall survival and DFS were summarized by extracting or deriving hazard ratio (HR) estimates. Random-effects meta-analyses were used to account for between-study heterogeneity and to summarize the effect of p53 across studies.
The meta-analyses gave a statistically significant pooled HR for overall survival in oral cavity [pooled HR, 1.48; 95% confidence interval, (95% CI), 1.03-2.11], and for disease-free survival in oral cavity (pooled HR, 1.47; 95% CI, 1.12-1.93) and in oropharynx (pooled HR, 0.45; 95% CI, 0.27-0.73). Despite attempts to limit it, between-study heterogeneity was large in the majority of meta-analyses and the prognostic value of p53 was generally inconsistent and inconclusive across studies.
The meta-analysis results highlight that current evidence about the prognostic value of p53 in patients with squamous cell carcinoma of the head and neck is inconclusive. Large heterogeneity exists across studies in study-level and patient-level characteristics, making it difficult to ascertain a clear picture. Future studies are required in which p53 expression is investigated in a more standardized and biologically informative manner. In particular, prospectively planned individual patient data meta-analyses are needed to establish the prognostic importance of p53 for specific subgroups of patients undergoing specific treatments.
总结目前关于喉、口咽、下咽或口腔鳞状细胞癌患者中存在突变或上调的 p53 是否为预后因素的证据。
使用系统搜索的严格标准确定相关文章。通过提取或推导风险比（HR）估计值，总结突变或上调的 p53 与野生型或低/无法检测到的 p53 与总生存期和无病生存期之间的关系。使用随机效应荟萃分析来解释研究间的异质性，并总结 p53 在研究间的效应。
荟萃分析得出了口腔癌总生存期的统计学显著汇总 HR（汇总 HR，1.48；95%置信区间[95%CI]，1.03-2.11），口腔癌无病生存期（汇总 HR，1.47；95%CI，1.12-1.93）和口咽癌无病生存期（汇总 HR，0.45；95%CI，0.27-0.73）。尽管尝试加以限制，但大多数荟萃分析中的研究间异质性很大，p53 的预后价值在研究间普遍不一致且不确定。
荟萃分析结果表明，目前关于头颈部鳞状细胞癌患者中 p53 预后价值的证据尚无定论。研究水平和患者水平特征的研究间存在很大的异质性，难以确定清晰的情况。需要进行未来的研究，以更标准化和更具生物学信息的方式研究 p53 的表达。特别是需要进行前瞻性计划的个体患者数据荟萃分析，以确定 p53 对接受特定治疗的特定患者亚组的预后重要性。
