Meta-Analysis
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World J Gastroenterol. Jan 28, 2014; 20(4): 1107-1113
Published online Jan 28, 2014. doi: 10.3748/wjg.v20.i4.1107
Meta-analysis of immunohistochemical expression of hypoxia inducible factor-1α as a prognostic role in gastric cancer
Shuang Lin, Rui Ma, Xue-Yong Zheng, Hong Yu, Xiao Liang, Hui Lin, Xiu-Jun Cai
Shuang Lin, Xue-Yong Zheng, Hong Yu, Xiao Liang, Hui Lin, Xiu-Jun Cai, Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Rui Ma, Department of Surgery, Zhejiang University Hospital, Zhejiang University, Hangzhou 310027, Zhejiang Province, China
Author contributions: Lin S and Cai XJ wrote the paper and performed the research; Cai XJ and Ma R designed the study; Zheng XY and Yu H collected the data; Liang X and Lin H performed the literature search and retrieved the data; and Cai XJ analyzed the data.
Correspondence to: Xiu-Jun Cai, MD, Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, No. 3, East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. cxjzu@hotmail.com
Telephone: +86-571-86006605 Fax: +86-571-86006276
Received: September 25, 2013
Revised: October 26, 2013
Accepted: November 12, 2013
Published online: January 28, 2014
Processing time: 123 Days and 13.2 Hours
Abstract

AIM: To conduct a meta-analysis to evaluate the prognostic role of hypoxia inducible factor-1α (HIF-1α) expression in gastric cancer.

METHODS: The PubMed, EMBASE, and Web of Science databases were searched systematically for all articles published in English before August, 2013. Pooled effect was calculated from the available data to evaluate the association between HIF-1α expression and 5-year overall survival and tumor clinicopathological features in gastric cancer patients. Pooled odds ratios (ORs) with 95%CIs were calculated using either a fixed-effects or a random-effects model.

RESULTS: Nine studies matched the selection criteria, which reported on 1103 subjects, 548 of whom had HIF-1α positive expression (50%). This meta-analysis indicated that HIF-1α positive expression in gastric cancer correlated with lower 5-year overall survival (OR = 0.36; 95%CI: 0.21-0.64), worse tumor differentiation (OR = 0.38; 95%CI: 0.23-0.64), deeper invasion (OR = 0.42; 95%CI: 0.32-0.57), higher rates of lymph node metastasis (OR = 2.23; 95%CI: 1.46-3.40), lymphatic invasion (OR = 2.50; 95%CI: 1.46-4.28), and vascular invasion (OR = 1.80; 95%CI: 1.29-2.51), and higher TNM stage (III + IV) (OR = 0.31; 95%CI: 0.15-0.60).

CONCLUSION: HIF-1α positive expression indicates a poor prognosis for patients with gastric cancer. Further studies are required to confirm these results.

Keywords: Hypoxia inducible factor-1α; Gastric cancer; 5-year overall survival; Clinicopathological features; Meta-analysis

Core tip: We conducted a meta-analysis to evaluate the correlation between hypoxia inducible factor-1α (HIF-1α) expression and clinical outcome in gastric cancer patients, and reported that HIF-1 positive expression indicates a poor prognosis for patients with gastric cancer. This is the first comprehensive and detailed meta-analysis to assess the association of HIF-1α positive expression with 5-year overall survival and tumor clinicopathological features for gastric cancer patients. We believed that the results will provide useful information for clinical decision-making regarding gastric cancer.