Abstract
BackgroundPrevious studies have yielded conflicting results regarding the relationship between p53 status and response to chemotherapy in patients with gastric cancer. We therefore performed a meta-analysis to expound the relationship between p53 status and response to chemotherapy.Methods/FindingsThirteen previously published eligible studies, including 564 cases, were identified and included in this meta-analysis. p53 positive status (high expression of p53 protein and/or a mutant p53 gene) was associated with improved response in gastric cancer patients who received chemotherapy (good response: risk ratio [RR] = 0.704; 95% confidence intervals [CI] = 0.550–0.903; P = 0.006). In further stratified analyses, association with a good response remained in the East Asian population (RR = 0.657; 95% CI = 0.488–0.884; P = 0.005), while in the European subgroup, patients with p53 positive status tended to have a good response to chemotherapy, although this did not reach statistical significance (RR = 0.828, 95% CI = 0.525–1.305; P = 0.417). As five studies used neoadjuvant chemotherapy (NCT) and one used neoadjuvant chemoradiotherapy (NCRT), we also analyzed these data, and found that p53 positive status was associated with a good response in gastric cancer patients who received chemotherapy-based neoadjuvant treatment (RR = 0.675, 95% CI = 0.463–0.985; P = 0.042).ConclusionThis meta-analysis indicated that p53 status may be a useful predictive biomarker for response to chemotherapy in gastric cancer. Further prospective studies with larger sample sizes and better study designs are required to confirm our findings.
Highlights
It is estimated that gastric cancer is the fourth most common cancer in the world [1]
This meta-analysis indicated that p53 status may be a useful predictive biomarker for response to chemotherapy in gastric cancer
Some studies suggest that only those patients who respond to neoadjuvant chemotherapy with tolerable toxicity will potentially benefit from this approach, while a proportion of patients fail to respond to neoadjuvant chemotherapy, or even progress during therapy [4,5,6]
Summary
It is estimated that gastric cancer is the fourth most common cancer in the world [1]. P53, the most studied gene, may be the primary candidate biomarker for predicting the response of gastric cancer to chemotherapy [7]. The gene encoding p53 is located on chromosome 17p and consists of 11 exons and 10 introns. Data regarding the use of p53 status as a biological marker to predict the response of gastric cancer to chemotherapy are inconclusive [14,15,16,17,18,19]. Some studies found that patients with p53 mutations or overexpression had higher response rates to chemotherapy than those with normal p53 status; other reports drew different conclusions. We conducted a meta-analysis to determine the value of p53 status in predicting response to chemotherapy in gastric cancer
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