Casanova João, Babiciu Alexandru, Duarte Gonçalo S, da Costa Ana Gomes, Serra Sofia Silvério, Costa Teresa, Catarino Ana, Leitão Mário M, Lima Jorge
Gynecologic Oncology Unit, Obstetrics and Gynecology Service, Department of Surgery, Hospital da Luz Lisboa, 1500-650 Lisbon, Portugal.
Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, 1649-004 Lisbon, Portugal.
Cancers (Basel). 2024 Dec 26;17(1):38. doi: 10.3390/cancers17010038.
Our primary objective was to evaluate the oncologic outcomes of patients with abnormal p53 FIGO grade 3 (high-grade) endometrioid endometrial cancer. As secondary objectives, we determined the global prevalence of abnormal p53 in grade 3 endometrioid endometrial carcinomas and the geographical variations.
The following electronic databases were searched: PubMed/Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. We followed the Meta-Analysis for Observational Studies in Epidemiology guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This review was preregistered with PROSPERO (no: CRD42023495192). Bias was assessed using the Quality in Prognosis Studies tool. For time-to-event data, the effect of p53 status on grade 3 endometrial cancer was described using hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Overall survival and progression-free survival were analyzed using one- and two-stage approaches, the Kaplan-Meier method, and Cox proportional hazards models.
Fifty-seven studies with 2528 patients were included. Patients with abnormal p53 had an increased risk of death (HR, 1.29 (95% CI, 1.11-1.48); I = 88%) and disease progression (HR, 1.63; 95% CI, 1.42-1.88; I = 2%) compared with patients with wildtype p53 G3 endometrial cancer. The global pooled prevalence of abnormal p53 was 30% (95% CI, 25-34%; tau = 0.02; I = 74%), with the highest prevalence being found in studies conducted in Asia (95% CI, 27-41%; tau = 0.01; I = 52%).
Abnormal p53 grade 3 endometrioid endometrial cancer is more common in Asia, and it is associated with decreased overall survival and progression-free survival.
我们的主要目的是评估p53异常的国际妇产科联盟（FIGO）3级（高级别）子宫内膜样子宫内膜癌患者的肿瘤学结局。作为次要目的，我们确定了3级子宫内膜样子宫内膜癌中p53异常的全球患病率以及地理差异。
检索了以下电子数据库：PubMed/Medline、EMBASE、Cochrane图书馆、Scopus和Web of Science。我们遵循了流行病学观察性研究的Meta分析指南以及系统评价和Meta分析的首选报告项目。本综述已在国际前瞻性系统评价注册库（PROSPERO）注册（编号：CRD42023495192）。使用预后研究质量工具评估偏倚。对于事件发生时间数据，使用风险比（HR）和相应的95%置信区间（CI）描述p53状态对3级子宫内膜癌的影响。使用单阶段和两阶段方法、Kaplan-Meier法和Cox比例风险模型分析总生存期和无进展生存期。
纳入了57项研究，共2528例患者。与野生型p53的G3子宫内膜癌患者相比，p53异常的患者死亡风险增加（HR，1.29（95%CI，1.11-1.48）；I²=88%），疾病进展风险增加（HR，1.63；95%CI，1.42-1.88；I²=2%）。p53异常的全球合并患病率为30%（95%CI，25-34%；tau²=0.02；I²=74%），在亚洲进行的研究中患病率最高（95%CI，27-41%；tau²=0.01；I²=52%）。
p53异常的3级子宫内膜样子宫内膜癌在亚洲更为常见，并且与总生存期和无进展生存期降低相关。
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