Mismatch repair status and clinical outcome in endometrial cancer: A systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée entre 1980 et 2011 (23 études), cette méta-analyse évalue l'association entre une déficience des gènes MMR et un pronostic défavorable chez des patientes atteintes d'un cancer de l'endomètre
Background The association between the deficiency in mismatch repair (MMR) genes and prognosis in women with endometrial cancer is unclear. Here we report a systematic review and meta-analysis exploring this association. Methods We searched literature databases (MEDLINE, EMBASE, and Cochrane) from 1980 until December 2011 to identify studies evaluating the association between MMR status and clinical outcome in endometrial cancer. The main outcome measures were overall survival (OS) and disease-free survival (DFS). Results Twenty-three studies met the inclusion criteria. The median sample size of studies was 112, 74% were retrospective case-series and 70% performed microsatellite instability (MSI) analysis to evaluate the status of MMR. Only 22% of studies used the panel of five microsatellite markers recommended by the National Cancer Institute. Seven studies used immunohistochemistry to define MMR deficiency, but only two of them determined the expression of all four MMR proteins. Overall, significant associations between MMR and outcome were observed in 32% of studies. There was marked inter-study heterogeneity for estimates of OS and DFS. Pooled analysis did not show any significant association between deficiency in MMR and worse OS (6 studies, hazard ratio [HR] 2.0, p = 0.11) or DFS (4 studies, HR ratio 1.31, p = 0.66). Conclusion There is no definitive evidence of a significant association between MMR status and detrimental survival in endometrial cancer.
Critical Reviews in Oncology/Hematology , résumé, 2012