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目的系统评价血浆纤维蛋白原表达水平与肾细胞癌患者临床病理特点及预后的相关性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年5期)、CNKI、CBM和Wan Fang Data数据库,搜集血浆纤维蛋白原表达水平与肾癌风险相关性的队列研究,检索时限均为建库至2016年5月。由2名研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用Rev Man 5.3软件对数据进行Meta分析。结果共纳入7个队列研究,共3 744例患者。Meta分析结果显示:血浆纤维蛋白原低表达组的肾细胞癌患者在总生存率[HR=2.13,95%CI(1.74,2.61),P<0.000 01]、肿瘤特异性生存率[HR=3.12,95%CI(2.19,4.44),P<0.000 01]方面均显著高于高表达组。亚组分析结果显示,血浆纤维蛋白原的表达水平在TNM临床分期Ⅲ~Ⅳ期明显高于Ⅰ~Ⅱ期[OR=0.27,95%CI(0.13,0.55),P=0.000 3],在Fuhrman病理分级G3+G4期明显高于G1+G2期[OR=0.49,95%CI(0.40,0.59),P<0.000 01],且差异均有统计学意义;但表达水平在性别上无差异[OR=0.85,95%CI(0.69,1.05),P=0.14]。结论现有证据表明,血浆纤维蛋白原的表达水平与肾细胞癌患者临床病理和预后具有明显相关性。受纳入研究数量和质量的限制,以上结论仍需进一步开展更多高质量的研究加以验证。
Objective To evaluate the relationship between the expression of plasma fibrinogen and the clinicopathological features and prognosis of patients with renal cell carcinoma. Methods The cohort of PubMed, EMbase, The Cochrane Library (2016), CNKI, CBM and Wan Fang Data was searched by computer to collect the correlation between plasma fibrinogen expression and risk of renal cell carcinoma Until May 2016. After two researchers independently screened the literature, extracted data, and assessed the risk of being included in the study, Meta-analysis of the data was performed using RevMan 5.3 software. Results A total of 7 cohort studies were included, with a total of 3 744 patients. The results of Meta analysis showed that the overall survival rate of patients with renal cell carcinoma [HR = 2.13,95% CI (1.74,2.61), P <0.000 01], tumor-specific survival rate [HR = 3.12 , 95% CI (2.19, 4.44), P <0.000 01]. The results of subgroup analysis showed that the expression of fibrinogen in stage Ⅲ ~ Ⅳ of TNM was significantly higher than that in stage Ⅰ ~ Ⅱ [OR = 0.27, 95% CI (0.13, 0.55), P = 0.0003] The pathological grade of G3 + G4 was significantly higher than that of G1 + G2 [OR = 0.49, 95% CI (0.40, 0.59), P <0.000 01], and the difference was statistically significant; OR = 0.85, 95% CI (0.69, 1.05), P = 0.14]. Conclusion The available evidence shows that the expression level of plasma fibrinogen is significantly correlated with the clinicopathology and prognosis of patients with renal cell carcinoma. Due to the limitation of the quantity and quality of the research, the above conclusion still needs to be further verified by more high-quality research.