The clinicopathological and prognostic significance of P27 in hepatocellular carcinoma patients: A systemic review and meta-analysis.

OBJECTIVES

P27 is a cyclin-dependent kinase inhibitor that has gained importance as a biomarker in human malignant tumors. However, the potential role of P27 in hepatocellular carcinoma remains unclear. The aim of this meta-analysis was to explore whether P27 acts as prognostic and clinicopathological roles in hepatocellular carcinoma patients.

METHODS/MATERIALS: An electronic search based on three databases, PubMed, Embase, and Web of Science, was performed to select a sufficient number of studies. Pooled hazard ratio (HR) and odds ratio (OR) were used as estimates to investigate the association among P27 expression, prognosis and clinicopathological features.

RESULTS

In total, we identified 18 studies with 1774 hepatocellular carcinoma patients. The result derived from four studies revealed a significant positive association between lower P27 levels and shorter overall survival (HR = 0.550, 95% CI: 0.464-0.652, P < 0001) and disease-free survival (HR = 0.420, 95% CI: 0.308-0.571, P < 0.0001). Analyses of the clinicopathological features and P27 expression also showed that a positive rate of P27 was significantly lower in a larger sized tumor (OR = 0.538, 95% CI: 0.315-0.919, P = 0.023). The results also revealed that lower P27 levels were correlated with poorer differentiation (0.416, 95% CI: 0.178-0.971, P = 0.043). Additionally, the pooled OR of 0.389 also presented a significant correlation between P27 underexpression and the metastasis of HCCs (95% CI: 0.155-0.975, P = 0.044).

CONCLUSIONS

This analysis suggests a strong association among P27 underexpression, poorer prognosis and aggressive progression of hepatocellular carcinoma in patients. P27 may be a tumor suppressor for predicting the progression and survival outcome in patients with hepatocellular carcinomas.