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目的采用Meta分析方法评价血管内皮生长因子(vascular endothelial growth factor,VEGF)在食管癌预后中的价值。方法计算机检索PubMed、EMbase中VEGF与食管癌预后相关性的回顾性队列研究,并辅以文献追溯方法查找相关文献。检索时限均从建库至2012年6月。由2名评价者按纳入与排除标准独立选择文献、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析,并用Begg’s漏斗图和Egger’s法评估文献的发表偏倚。结果最终纳入10个队列研究,共811例食管癌患者。Meta分析结果显示,VEGF高表达的食管癌患者死亡风险更高[HR=1.55,95%C(I1.25,1.91)]。进一步按VEGF亚型、VEGF表达临界值及患者来源进行的亚组分析结果显示,VEGF-C在组织的高表达与预后并无显著联系。临界值为10%的VEGF亚组在肿瘤组织的高表达提示死亡风险更高,而临界值为30%的亚组VEGF表达水平与预后并无显著联系。中国患者VEGF在肿瘤组织的高表达较非中国患者对预测食管癌预后更具价值。结论 VEGF在肿瘤组织的表达水平对食管癌的预后具有预测价值。
Objective To evaluate the value of vascular endothelial growth factor (VEGF) in the prognosis of esophageal cancer by Meta-analysis. Methods A retrospective cohort study of the correlation between VEGF and the prognosis of esophageal cancer in PubMed and EMbase was searched by computer. The related literatures were searched by literature retrospective method. Search time limit from the construction of the library to June 2012. Two reviewers independently selected the literature on inclusion and exclusion criteria, extracted data, and evaluated the quality. Meta-analysis was performed using RevMan 5.0 software and publication bias was assessed using Begg’s funnel plot and Egger’s method. The results were finally included in 10 cohort studies, a total of 811 cases of esophageal cancer patients. Meta-analysis showed that patients with esophageal cancer with high expression of VEGF had a higher risk of death [HR = 1.55, 95% C (I 1.25, 1.91)]. Further subgroup analysis of VEGF subtype, VEGF expression threshold and patient source showed that there was no significant correlation between VEGF-C high expression and prognosis. The high expression of VEGF in the subgroup of 10% of the VEGF subgroups with higher risk of death was associated with a higher risk of death, whereas the subgroup of 30% of the subgroups with the cut-off value of 10% had no significant association with prognosis. Chinese patients with high expression of VEGF in tumor tissue than non-Chinese patients predict the prognosis of esophageal cancer is more valuable. Conclusion The expression level of VEGF in tumor tissue has predictive value for the prognosis of esophageal cancer.