Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba-SP, Brazil.
Unit of Cancer Research and Translational Medicine, Faculty of Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
J Oral Pathol Med. 2018 May;47(5):443-453. doi: 10.1111/jop.12623. Epub 2017 Sep 5.
To perform a meta-analysis to assess whether the presence of cancer-associated fibroblasts (CAF) is a prognostic marker of oral squamous cell carcinomas (OSCC).
Immunohistochemical studies assessing the prognostic relevance of CAF (alpha smooth muscle actin (α-SMA)-positive fibroblasts) in patients with OSCC were systematically reviewed using Cochrane, Lilacs, PubMed, Scopus, and Web of Science databases. The outcomes assessed were overall survival (OS) and disease-free survival (DFS). The meta-analysis was performed using the random- and fixed-effects model with adjusted hazard ratio (HR) and 95% confidence intervals (95% CI) as effect measures. The methodological quality of the included studies was assessed using the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool, and the evidence quality was assessed by the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system.
The presence of high levels of CAF in the stroma of OSCC predicted shortened time to DFS (HR = 3.32, 95% CI: 2.09-5.26, P < .00001) and an overall decrease in survival (HR: 2.16, 95% CI: 1.60-2.92, P < .00001). Moreover, high presence of CAF was frequently reported in association with parameters that worsen the prognosis in OSCC, including advanced disease stage (TNM classification), recurrence, tumor grade, depth of invasion, vascular, lymphatic and neural invasion, and extranodal metastatic spread.
The presence of CAF, as assessed by α-SMA-positive fibroblasts in the stroma, indicates poor prognosis in patients with OSCC.
进行荟萃分析以评估癌症相关成纤维细胞（CAF）的存在是否是口腔鳞状细胞癌（OSCC）的预后标志物。
系统地检索了 Cochrane、Lilacs、PubMed、Scopus 和 Web of Science 数据库中的免疫组织化学研究，以评估 CAF（α平滑肌肌动蛋白（α-SMA）阳性成纤维细胞）在 OSCC 患者中的预后相关性。评估的结局包括总生存（OS）和无病生存（DFS）。使用随机和固定效应模型以及调整后的风险比（HR）和 95%置信区间（95%CI）作为效应量进行荟萃分析。使用 Meta 分析统计评估和审查工具（MAStARI）工具评估纳入研究的方法学质量，并使用推荐评估、制定与评估（GRADE）系统评估证据质量。
OSCC 基质中高水平 CAF 的存在预示着 DFS 时间缩短（HR=3.32，95%CI：2.09-5.26，P<.00001）和总体生存率降低（HR：2.16，95%CI：1.60-2.92，P<.00001）。此外，CAF 的高存在常与 OSCC 预后恶化的参数相关，包括疾病进展期（TNM 分类）、复发、肿瘤分级、浸润深度、血管、淋巴和神经浸润以及淋巴结外转移。
通过基质中 α-SMA 阳性成纤维细胞评估 CAF 的存在表明 OSCC 患者预后不良。
