Xu Yuyang, Zhang Yingyi, Wang Zihuai, Chen Nan, Zhou Jian, Liu Lunxu
Department of Thoracic Surgery, West China Hospital Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer West China School of Medicine, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2017 Sep;96(37):e8063. doi: 10.1097/MD.0000000000008063.
Angiogenesis is an essential process in the development and progression of malignant tumors including lung cancer, in which angiopoietin-2 (Ang-2) plays an important role. The objective of this study was to assess the prognostic value of serum Ang-2 levels in patients with lung cancer.
A comprehensive systematic electronic search was performed in the Pubmed, Embase, Web of Science, china national knowledge infrastructure, and VIP databases update to October, 2016 (qikan.cqvip.com). Literatures examining the relevance of serum Ang-2 levels to progression and prognosis of lung cancer were eligible for our study. Standardized mean differences (SMD) with 95% confidence interval (95% CI) and a P value were applied to compare continuous variables, and hazard ratio (HR) with 95% CI as well as P value were applied for prognostic role.
Twenty studies with 1911 patients met the eligibility criteria. Among them, 7 studies with 575 patients with lung cancer assessed the association between expression of serum Ang-2 and prognosis. According to our results, higher levels of serum Ang-2 were associated with the later stage of tumor. Serum Ang-2 levels were significantly lower in stage I than in stage II (SMD: -0.51; 95% CI: -0.75 to -0.27; P < .001), in stage II than in stage III (SMD: -0.52; 95% CI: -0.80 to -0.24; P < .001), in stage III than in stage IV (SMD: -0.58; 95% CI: -0.93 to -0.23; P = .001). In addition, serum Ang-2 levels were higher in patients with lymph node metastasis (SMD: 1.06; 95% CI, 0.57-1.56; P < .001). Meanwhile, patients with lung cancer with higher levels of serum Ang-2 were associated with a significant poorer prognosis when compared to those with lower serum Ang-2 levels (HR: 1.64; 95% CI: 1.20-2.25; P = .002), and this role was further detected when stratified by ethnicity and histological type.
This systematic review and meta-analysis suggested that serum Ang-2 levels might be a potential predictor for staging, and were associated with prognosis of lung cancer.
血管生成是包括肺癌在内的恶性肿瘤发生和发展过程中的一个重要过程，血管生成素-2（Ang-2）在其中发挥重要作用。本研究的目的是评估血清Ang-2水平在肺癌患者中的预后价值。
在Pubmed、Embase、Web of Science、中国知网和维普数据库中进行全面系统的电子检索，检索截至2016年10月（qikan.cqvip.com）的文献。研究血清Ang-2水平与肺癌进展和预后相关性的文献符合本研究要求。应用标准化均数差（SMD）及95%置信区间（95%CI）和P值比较连续变量，应用风险比（HR）及95%CI和P值评估预后作用。
20项研究共1911例患者符合纳入标准。其中，7项研究共575例肺癌患者评估了血清Ang-2表达与预后的关系。根据研究结果，血清Ang-2水平越高与肿瘤分期越晚相关。血清Ang-2水平在I期显著低于II期（SMD：-0.51；95%CI：-0.75至-0.27；P<0.001），II期低于III期（SMD：-0.52；95%CI：-0.80至-0.24；P<0.001），III期低于IV期（SMD：-0.58；95%CI：-0.93至-0.23；P=0.001）。此外，有淋巴结转移患者的血清Ang-2水平更高（SMD：1.06；95%CI，0.57 - 1.56；P<0.001）。同时，血清Ang-2水平较高的肺癌患者与血清Ang-2水平较低的患者相比，预后显著更差（HR：1.64；95%CI：1.20 - 2.25；P=0.002），按种族和组织学类型分层时该作用进一步得到证实。
本系统评价和荟萃分析表明，血清Ang-2水平可能是分期的潜在预测指标，并与肺癌预后相关。
