Abstract
The phosphatase and tensin homolog (PTEN) gene is suggested to be a dormant tumor suppressor. However, the prognostic value of the loss of PTEN expression in renal cell carcinoma (RCC) remains controversial. Therefore, we conducted a meta-analysis to evaluate the association of PTEN expression with the clinicopathological presentations and outcomes of patients with RCC through immunohistochemistry staining analysis. We systematically searched for relevant studies in PubMed, Web of Science, and Embase until March 2016. Data regarding clinical stage, pathological type, Fuhrman grade, overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS) was analyzed in the present study. In total, there were 12 studies with 2,368 patients included in this meta-analysis. The low PTEN expression in RCC was significantly associated with unfavorable DSS (HR = 1.568, 95% CI 1.015–2.242) in a random-effects model but not with OS (HR = 1.046, 95% CI 0.93–1.176) and PFS (HR = 1.244, 95% CI 0.907–1.704). Other results indicated that PTEN expression was not correlated with clinical stage, pathological type, and Fuhrman grade. This meta-analysis suggests that PTEN expression is of limited value in predicting the prognosis of patients with RCC for OS and PFS via immunohistochemistry staining analysis; and that for DSS, low PTEN expression is significantly associated with an unfavorable outcome.
Highlights
33 articles were excluded, including: five that lacked of biomarkers; 12 missing detailed analysis on the prognostic value of phosphatase and tensin homolog (PTEN); four whose endpoint was neither overall survival (OS), progression-free survival (PFS), nor disease-specific survival (DSS); six that had no extractable data; and eight in which HR was not dichotomized
Our findings showed that low PTEN expression levels corresponded to significantly shorter DSS, whereas in OS and PFS, the tendency did not reach statistical significance
The detection method of the included studies was immunohistochemistry staining analysis, which involved the use of different antibodies and processing methods that may have provided inconsistent results for prognostic markers. The results of this meta-analysis showed that low PTEN expression was significantly associated with adverse prognosis with regard to DSS
Summary
We systematically searched for relevant studies in PubMed, Web of Science, and Embase until March 2016. “PTEN,” “phosphatase and tensin homolog,” “renal or kidney,” “neoplasm, tumor, cancer, or carcinoma,” and “prognosis, outcome, progress, mortality, and survival” were used as search terms. Studies were included in this metaanalysis if they met the following inclusion criteria: (1) investigated the clinical presentations and prognosis of patients with RCC; (2) detected PTEN protein expression intensity in immunohistochemistry staining analysis; and (3) evaluated the correlation between PTEN protein expression and clinical presentations as well as survival outcomes [overall survival (OS), disease-specific survival (DSS) and (disease-free survival (DFS)]. The exclusion criteria were: (1) papers not written in English; (2) case reports, review articles, conference abstracts, or editorial comments; and (3) determination of PTEN expression by other methods, including RT-PCR and Western blot analysis
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