Zhou He, Huang Tao, Xiong Yongfu, Peng Linglong, Wang Rong, Zhang Guang Jun
The Second Department of Gastrointestinal Surgery.
Department of Gastroenterology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province.
Medicine (Baltimore). 2018 Dec;97(50):e13752. doi: 10.1097/MD.0000000000013752.
A number of studies have attempted to determine the prognostic significance of proliferating cell nuclear antigen (PCNA) in patients with colorectal cancer (CRC), but the reports are controversial and inconsistent. Thus, we conducted a meta-analysis to clarify the value of PCNA in CRC prognosis.
A systematic search of relevant studies was performed in 4 electronic databases including PubMed, Cochrane Library, Embase, and Web of Science until February 2018. Hazard ratios (HRs) combined with 95% confidence intervals (95% CIs) were used to evaluate the relationship of PCNA expression with overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).
A total of 1372 CRC patients in 14 studies were identified eventually in our meta-analysis. The pooled HRs demonstrated that CRC patients with high PCNA expression was significantly correlated with poor OS (HR = 1.81; 95% CI: 1.51-2.17; P = .000), CSS (HR = 1.99; 95% CI: 1.04-3.79; P = .037); but not significantly with DFS (HR = 2.48; 95% CI: 0.98-6.26; P = .055). Sensitivity analysis showed the pooled HRs for OS, CSS, and DFS were stable when the included studies were removed one by one.
Our meta-analysis suggested that high PCNA expression was associated with poor prognosis, and it could serve as a reliable and prognostic biomarker in CRC patients. More large-scale studies are needed to further support the conclusion.
多项研究试图确定增殖细胞核抗原（PCNA）在结直肠癌（CRC）患者中的预后意义，但报告存在争议且不一致。因此，我们进行了一项荟萃分析以阐明PCNA在CRC预后中的价值。
在包括PubMed、Cochrane图书馆、Embase和科学网在内的4个电子数据库中进行了相关研究的系统检索，直至2018年2月。采用风险比（HR）结合95%置信区间（95%CI）来评估PCNA表达与总生存期（OS）、癌症特异性生存期（CSS）和无病生存期（DFS）之间的关系。
在我们的荟萃分析中最终确定了14项研究中的1372例CRC患者。汇总的HR显示，PCNA高表达的CRC患者与较差的OS（HR = 1.81；95%CI：1.51 - 2.17；P = 0.000）、CSS（HR = 1.99；95%CI：1.04 - 3.79；P = 0.037）显著相关；但与DFS无显著相关性（HR = 2.48；95%CI：0.98 - 6.26；P = 0.055）。敏感性分析表明，当逐一剔除纳入研究时，OS、CSS和DFS的汇总HR是稳定的。
我们的荟萃分析表明，PCNA高表达与预后不良相关，它可作为CRC患者可靠的预后生物标志物。需要更多大规模研究来进一步支持这一结论。
