Zhang Qingyu, Liu Fanxiao, Wang Bomin, Li Zhenfeng, Zhou Dongsheng, Yang Qiang, Dong Jinlei, Li Jianmin
Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, China Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China.
Medicine (Baltimore). 2016 Jun;95(23):e3661. doi: 10.1097/MD.0000000000003661.
Numerous original clinical studies have attempted to investigate the prognostic value of HER-2 overexpression in osteosarcoma, but the results of these studies are not consistent. This meta-analysis and systematic review was performed to further assess the correlation between HER-2 expression and prognosis in patients with osteosarcoma. A detailed search of relevant publications was conducted using 7 electronic databases: PubMed, Embase, the Cochrane library, the Wanfang database, the China National Knowledge Internet (CNKI) database, the Chinese VIP database, and the Chinese Biological Medical (CBM) Database for publications through August 1, 2015, using the following keywords (HER-2 OR ErbB-2 OR C-erbB-2 OR neu) AND (osteosarcoma OR osteogenic tumor). The bibliographies of potentially relevant articles and identified articles were then searched by hand. Eligible studies were those that enrolled participants with osteosarcoma and provided survival outcome in HER-2 positive and negative groups. The hazard ratio (HR) and 95% confidence interval (CI) for each individual study was calculated and pooled to obtain integrated estimates, using random effects modeling. Sixteen studies involving 934 participants with osteosarcoma met our inclusion criteria. HER-2 overexpression was documented in 42.2% of patients with osteosarcoma. Compared with patients without HER-2 overexpression, those overexpressing HER-2 had decreased overall survival (HR = 2.03, 95% CI: 1.36-3.03, P < 0.001). Statistical associations between HER-2 overexpression and unfavorable overall survival (OS) were observed for both biopsy and surgical removal specimens (HR = 2.07, 95%CI: 1.16-3.72, P = 0.014; and HR = 2.02, 95%CI: 1.10-3.71, P = 0.024). Results for disease-free survival (DFS) were similar. Overexpression of HER-2 is significantly associated with poor outcome for patients with osteosarcoma and should be assessed at diagnosis and after surgery as a prognostic factor. However, larger-scale multicenter clinical studies are needed to further support these findings.
众多原创临床研究试图探究HER-2过表达在骨肉瘤中的预后价值，但这些研究结果并不一致。进行此项荟萃分析和系统评价以进一步评估HER-2表达与骨肉瘤患者预后之间的相关性。使用7个电子数据库对相关出版物进行了详细检索：PubMed、Embase、Cochrane图书馆、万方数据库、中国知网（CNKI）数据库、中文维普数据库和中国生物医学文献数据库（CBM），检索截至2015年8月1日的出版物，使用以下关键词（HER-2或ErbB-2或C-erbB-2或neu）和（骨肉瘤或成骨性肿瘤）。然后手动检索潜在相关文章和已识别文章的参考文献。符合条件的研究是那些纳入骨肉瘤患者并提供HER-2阳性和阴性组生存结果的研究。使用随机效应模型计算并汇总每个个体研究的风险比（HR）和95%置信区间（CI）以获得综合估计值。16项涉及934例骨肉瘤患者的研究符合我们的纳入标准。42.2%的骨肉瘤患者有HER-2过表达记录。与无HER-2过表达的患者相比，HER-2过表达的患者总生存期降低（HR = 2.03，95%CI：1.36 - 3.03，P < 0.001）。对于活检标本和手术切除标本，均观察到HER-2过表达与不良总生存期（OS）之间的统计学关联（HR = 2.07，95%CI：1.16 - 3.72，P = 0.014；以及HR = 2.02，95%CI：1.10 - 3.71，P = 0.024）。无病生存期（DFS）的结果相似。HER-2过表达与骨肉瘤患者的不良预后显著相关，应在诊断时和手术后作为预后因素进行评估。然而，需要更大规模的多中心临床研究来进一步支持这些发现。
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