Prognostic value of excision repair cross-complementation group 1 expression in gastric cancer: A meta-analysis

Abstract

The prognostic impact of excision repair cross-complementation group 1 (ERCC1) expression in gastric cancer (GC) has been investigated for decades, but has yielded controversial results. The aim of the present study was to provide a precise evaluation of whether the expression levels of ERCC1 are associated with overall survival (OS) in patients with GC. A systematic search of Medline and Embase was conducted. Original studies concerning OS and ERCC1 expression were included for critical appraisal. A total of 15 studies comprising 1,425 patients with GC were identified. The results revealed that high/positive ERCC1 expression was an indicator of poor survival in patients with GC [hazard ratio (HR) 1.48; 95% confidence interval (CI) 1.02-2.10; P=0.036; I²=83.8%; random-effects model] compared with low/negative ERCC1 expression. Subgroup analysis indicated that high/positive ERCC1 expression had a significant unfavorable impact on OS in the group of patients evaluated by reverse transcription polymerase chain reaction (RT-PCR; HR 2.57; 95% CI 1.49-4.45). Furthermore, high/positive ERCC1 expression was found to be associated with poor survival in patients receiving platinum-based chemotherapy in the RT-PCR group (HR 2.13; 95% CI 1.06-4.27). These data suggest that ERCC1 may be a useful prognostic factor for GC. In addition, low mRNA levels of ERCC1 appear to be associated with a significant favorable OS benefit from platinum-based chemotherapy.

Keywords: excision repair cross-complementation group 1; gastric cancer; meta-analysis.

Figure 1

Flowchart of articles identified with criteria for inclusion and exclusion.

Figure 2

Pooled HRs for overall survival in patients with gastric cancer. The size of each square is proportional to the weight of the study (inverse of variance). HR, hazard ratio; CI, confidence interval; ICH, immunohistochemistry; RT-PCR, reverse transcription polymerase chain reaction.

Figure 3

Pooled HRs for OS in GC patients receiving platinum-based chemotherapy. The size of each square is proportional to the weight of the study (inverse of variance). HR, hazard ratio; CI, confidence interval; OS, overall survival; GC, gastric cancer; ICH, immunohistochemistry; RT-PCR, reverse transcription polymerase chain reaction.

Figure 4

Influence analysis of the pooled hazard ratio for overall survival. Meta-analysis random effects estimates (exponential form) were used. Results were computed by omitting each study (on the left) in turn. The two ends of every broken line represented the 95% confidence interval.

Figure 5

Cumulative meta-analysis showing the time-tendency of the HR for OS. HR, hazard ratio; CI, confidence interval, OS, overall survival.

Figure 6

Funnel plot of the estimated publication bias of the included studies. HR, hazard ratio; SE, standard error.