Chen Xishan, Liang Renba, Lai Lin, Chen Kaihua, Zhu Xiaodong
Department of Oncology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning, China.
Front Oncol. 2021 Aug 19;11:697369. doi: 10.3389/fonc.2021.697369. eCollection 2021.
The prognostic value of epidermal growth factor receptor (EGFR)/phosphorylated EGFR (p-EGFR) expression in nasopharyngeal carcinoma remains controversial. A meta-analysis was performed to investigate prognostic significance of EGFR/p-EGFR expression in patients with nasopharyngeal carcinoma.
Literatures published before November 2020 were systematically searched in relevant databases, including PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wan fang databases. STATA 13 statistical software was used to analyze the pooled hazard ratio (HR) and 95% confidence interval (CI). Heterogeneity of the studies was examined by I. Sensitivity and subgroup analysis were performed to explore sources of heterogeneity. The potential publication bias was assessed using both Egger's and Begg's tests.
A total of 20 literatures with 1545 patients were included for the meta-analysis. The meta-analysis results suggested that high expression of EGFR was significantly associated with poor overall survival (OS) (HR = 1.70, 95% CI: 1.24-3.15, P = 0.001) and disease-free survival (DFS) (HR = 2.58, 95% CI: 1.87-3.56, P = 0.000). However, it was not significantly associated with progression-free survival (PFS) (HR = 1.85, 95% CI: 0.90-3.82, P = 0.09) and distant metastasis-free survival (DMFS) (HR = 1.39, 95% CI: 0.73-2.67, P = 0.319). The subgroup analysis indicated that patients with EGFR high expression in studies of higher TNM stage (III-IV) ratio had significantly poor OS (HR = 2.27, 95% CI: 1.09-4.73, P = 0.03), but heterogeneity existed in studies (I = 95.1%, P = 0.000). Sensitivity analyses revealed that EGFR expression did not significantly affect OS by an individual study solely, indicating there was inherent heterogeneity in OS cohorts. There was no significant heterogeneity among eight studies in the DFS cohorts (I = 0%, P = 0.606). There was significant heterogeneity between EGFR expression and DMFS (I = 82.8%, P = 0.000). Sub-group analysis in differentiated carcinoma demonstrated a smaller heterogeneity (I = 33.2%). In addition, p-EGFR high expression had no significant correlation with OS (HR = 1.00, 95% CI: 0.88-1.14, P = 0.982) and DMFS (HR = 1.21, 95% CI: 0.96-1.52, P = 0.112). The heterogeneity among p-EGFR and OS studies was small (I = 21%, P = 0.26). There was no significant heterogeneity in the DMFS cohorts (I = 0%, P = 0.497).
EGFR high-expression was significantly associated with poor OS and DFS, which may serve as a prognostic predictor for nasopharyngeal cancer.
[https://www.crd.york.ac.uk/PROSPERO], identifier [number CRD42021258457].
表皮生长因子受体（EGFR）/磷酸化表皮生长因子受体（p-EGFR）表达在鼻咽癌中的预后价值仍存在争议。进行一项荟萃分析以探讨EGFR/p-EGFR表达在鼻咽癌患者中的预后意义。
在包括PubMed、Web of Science、Embase、中国知网（CNKI）和万方数据库在内的相关数据库中系统检索2020年11月之前发表的文献。使用STATA 13统计软件分析合并风险比（HR）和95%置信区间（CI）。通过I²检验研究的异质性。进行敏感性和亚组分析以探索异质性来源。使用Egger检验和Begg检验评估潜在的发表偏倚。
共纳入20篇文献中的1545例患者进行荟萃分析。荟萃分析结果表明，EGFR高表达与总生存期（OS）差显著相关（HR = 1.70，95%CI：1.24 - 3.15，P = 0.001）和无病生存期（DFS）差显著相关（HR = 2.58，95%CI：1.87 - 3.56，P = 0.000）。然而，它与无进展生存期（PFS）无显著相关性（HR = 1.85，95%CI：0.90 - 3.82，P = 0.09）和无远处转移生存期（DMFS）无显著相关性（HR = 1.39，95%CI：0.73 - 2.67，P = 0.319）。亚组分析表明，在TNM分期较高（III - IV期）比例的研究中，EGFR高表达的患者OS显著较差（HR = 2.27，95%CI：1.09 - 4.73，P = 0.03），但研究中存在异质性（I² = 95.1%，P = 0.000）。敏感性分析显示，单独一项研究中EGFR表达对OS无显著影响，表明OS队列中存在内在异质性。DFS队列中的八项研究之间无显著异质性（I² = 0%，P = 0.606）。EGFR表达与DMFS之间存在显著异质性（I² = 82.8%，P = 0.000）。分化型癌的亚组分析显示异质性较小（I² = 33.2%）。此外，p-EGFR高表达与OS（HR = 1.00，95%CI：0.88 - 1.14，P = 0.982）和DMFS（HR = 1.21，95%CI：0.96 - 1.52，P = 0.112）无显著相关性。p-EGFR与OS研究之间的异质性较小（I² = 21%，P = 0.26）。DMFS队列中无显著异质性（I² = 0%，P = 0.497）。
EGFR高表达与OS和DFS差显著相关，这可能作为鼻咽癌的预后预测指标。
