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. 2016 Apr 26:9:2447-53.
doi: 10.2147/OTT.S98577. eCollection 2016.

E-cadherin expression and prognosis of head and neck squamous cell carcinoma: evidence from 19 published investigations

Xusheng Ren  1 , Jianning Wang  2 , Xuefen Lin  3 , Xuxia Wang  3
Affiliations

E-cadherin expression and prognosis of head and neck squamous cell carcinoma: evidence from 19 published investigations

Xusheng Ren et al. Onco Targets Ther. .

Abstract

Objective: The objective of this study was to review the published literature and investigate whether E-cadherin gene is a prognostic factor in head and neck squamous cell carcinoma by conducting a meta-analysis.

Methods: Studies were identified from the databases Embase, Medline, and Cochrane Library by using the keywords "E-cadherin gene" and "head and neck cancer". Overall survival (OS) and disease-free survival (DFS) were the primary outcome measurements.

Results: Our literature review identified 1,458 articles; 19 studies with a total number of 2,012 cases were eligible for inclusion in the meta-analysis. The hazard ratio (HR) for OS of patients with decreased expression of E-cadherin gene was 0.57 (95% CI =0.37, 0.89; P=0.000). However, statistical heterogeneity was unacceptably high (I (2)=74.5%, P=0.000). After sensitivity analysis, heterogeneity became acceptable, and the effect measure was still significant (I (2)=7.0%; HR =0.52; 95% CI =0.40, 0.66; P=0.000). The HR for DFS was 0.53 (95% CI =0.42, 0.67; P=0.000).

Conclusion: This meta-analysis showed clear evidence that high E-cadherin gene expression is a positive prognostic factor of head and neck squamous cell carcinoma, resulting in better OS and DFS. However, this conclusion must be interpreted with caution due to a few limitations.

Keywords: E-cadherin gene; head and neck squamous cell carcinoma; immunohistochemistry; prognosis.

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Figures

Figure 1
Figure 1
A flow diagram of literature search.
Figure 2
Figure 2
A forest plot for overall survival. Notes: The difference between the two groups was significant (HR =0.57; 95% CI =0.37, 0.89; P=0.000). However, there was great statistical heterogeneity (I2=74.5%, P=0.000). After sensitivity analysis, heterogeneity became acceptable (I2=7.0%) and the effect measure remained significant (HR =0.52; 95% CI =0.40, 0.66; P=0.000). “1” means after sensitivity analysis and “1+2” means before sensitivity analysis. Weights are from random effects analysis. Abbreviations: HR, hazard ratio; CI, confidence interval.
Figure 3
Figure 3
A forest plot for overall survival. Note: The difference between the high E-cadherin group and the low E-cadherin group was significant (HR =0.53; 95% CI =0.42, 0.67; P=0.000) and the heterogeneity was acceptable (I2=0.0%, P=0.860). Abbreviations: HR, hazard ratio; CI, confidence interval.
Figure 4
Figure 4
A funnel plot of meta-analysis of overall survival. Note: According to the funnel plot, there is an asymmetry. Abbreviations: HR, hazard ratio; SE, standard error; CI, confidence interval.
Figure 5
Figure 5
A funnel plot of meta-analysis of disease-free survival. Note: According to the funnel plot, there is an asymmetry. Abbreviations: HR, hazard ratio; SE, standard error; CI, confidence interval.
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