Xu Hai-Yuan, Xu Wen-Lin, Wang Li-Qiang, Chen Min-Bin, Shen Hui-Ling
Department of Medical Oncology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, People's Republic of China.
Department of Central Laboratory, Zhenjiang Fourth People's Hospital Affiliated to Jiangsu University, Zhenjiang, People's Republic of China.
PLoS One. 2014 Apr 16;9(4):e95371. doi: 10.1371/journal.pone.0095371. eCollection 2014.
Previous studies have yielded conflicting results regarding the relationship between p53 status and response to chemotherapy in patients with gastric cancer. We therefore performed a meta-analysis to expound the relationship between p53 status and response to chemotherapy.
METHODS/FINDINGS: Thirteen previously published eligible studies, including 564 cases, were identified and included in this meta-analysis. p53 positive status (high expression of p53 protein and/or a mutant p53 gene) was associated with improved response in gastric cancer patients who received chemotherapy (good response: risk ratio [RR] = 0.704; 95% confidence intervals [CI] = 0.550-0.903; P = 0.006). In further stratified analyses, association with a good response remained in the East Asian population (RR = 0.657; 95% CI = 0.488-0.884; P = 0.005), while in the European subgroup, patients with p53 positive status tended to have a good response to chemotherapy, although this did not reach statistical significance (RR = 0.828, 95% CI = 0.525-1.305; P = 0.417). As five studies used neoadjuvant chemotherapy (NCT) and one used neoadjuvant chemoradiotherapy (NCRT), we also analyzed these data, and found that p53 positive status was associated with a good response in gastric cancer patients who received chemotherapy-based neoadjuvant treatment (RR = 0.675, 95% CI = 0.463-0.985; P = 0.042).
This meta-analysis indicated that p53 status may be a useful predictive biomarker for response to chemotherapy in gastric cancer. Further prospective studies with larger sample sizes and better study designs are required to confirm our findings.
既往研究在胃癌患者中p53状态与化疗反应的关系方面得出了相互矛盾的结果。因此，我们进行了一项荟萃分析以阐明p53状态与化疗反应之间的关系。
方法/结果：确定了13项先前发表的符合条件的研究，包括564例病例，并纳入本荟萃分析。p53阳性状态（p53蛋白高表达和/或p53基因突变）与接受化疗的胃癌患者的反应改善相关（良好反应：风险比[RR]=0.704；95%置信区间[CI]=0.550-0.903；P=0.006）。在进一步的分层分析中，东亚人群中与良好反应的关联仍然存在（RR=0.657；95%CI=0.488-0.884；P=0.005），而在欧洲亚组中，p53阳性状态的患者倾向于对化疗有良好反应，尽管这未达到统计学意义（RR=0.828，95%CI=0.525-1.305；P=0.417）。由于5项研究使用了新辅助化疗（NCT），1项研究使用了新辅助放化疗（NCRT），我们也分析了这些数据，发现p53阳性状态与接受基于化疗的新辅助治疗的胃癌患者的良好反应相关（RR=0.675，95%CI=0.463-0.985；P=0.042）。
这项荟萃分析表明，p53状态可能是胃癌化疗反应的一个有用的预测生物标志物。需要进一步进行样本量更大、研究设计更好的前瞻性研究来证实我们的发现。
