Prognostic value of progesterone receptor expression in ovarian cancer: a meta-analysis

Abstract

Objective: While a prognosis value of progesterone receptor (PR) in ovarian cancer has been reported in some publications, controversial data were presented by different reports. In order to address the disagreement of progesterone receptor in ovarian cancer survival, we conducted this meta-analysis.

Methods: Relevant articles on progesterone receptor and ovarian cancer prognosis were identified via a thorough search of PubMed, Embase and Cochrane Central. Hazard ratios (HR) and 95% confidence interval (CI) were extracted from studies on overall survival (OS) and disease-free survival (DFS)/progress-free survival (PFS)/recurrence-free survival (RFS).

Result: A total of 28 eligible studies containing 5685 patients were collected for analysis. It was found that progesterone receptor positivity was significantly associated with favorable overall survival (OS) (HR = 0.86, 95% CI = 0.78 to 0.95, P = 0.002) and disease-free survival (DFS)/progress-free survival (PFS)/recurrence-free survival (RFS) (HR = 0.75, 95% CI = 0.61 to 0.93, P = 0.008) of ovarian cancer patients. Subgroup analysis showed that progesterone receptor expression was associated with a favorable prognosis of unclassified ovarian cancer, European origin, and immunohistochemical detection method.

Conclusion: Progesterone receptor expression can be used as a favorable prognostic predictor in ovarian cancer managements.

Keywords: meta-analysis; ovarian cancer; progesterone receptor; prognostic.

Figure 1. Flow of study identification, inclusion, and exclusion

Figure 2. Forest plot of HR and 95% CI of the association between progesterone receptor expression and overall survival of ovarian cancer

Summary of all 26 trails, the results showed progesterone receptor was associated with a favorable OS of ovarian cancer using random effects model. The % weight was computed automatically by the Stata software.

Figure 3. Subgroup analyses of the relationship between progesterone receptor expression and overall survival of ovarian cancer

Figure 4. Forest plot of HR and 95% CI of the association between progesterone receptor expression and disease-free survival/progress-free survival/recurrence-free survival of ovarian cancer patients

Summary of all 15 trails, the results showed progesterone receptor was associated with a favorable DFS/PFS/RFS of ovarian cancer using random effects model.

Figure 5. Subgroup analyses of the relationships between progesterone receptor and disease-free survival/progress-free survival/recurrence-free survival of ovarian cancer

Figure 6

A. Sensitivity analysis of the association between progesterone receptor expression and overall survival in ovarian cancer patients. B. Sensitivity analysis of the association between progesterone receptor expression and disease-free survival/progress-free survival/recurrence-free survival in ovarian cancer patients. The leave-one-out method was used to confirm the stability of the results.

Figure 7

A. Funnel plot for the publication bias test between progesterone receptor expression and overall survival. B. Funnel plot for the publication bias test between progesterone receptor expression and disease-free survival/progress-free survival/recurrence-free survival. Visual inspection of the Begg's funnel plot did not indicated substantial asymmetry.

Figure 8

A. Egger's publication bias plot of the studies assessing progesterone receptor and overall survival in ovarian cancer. B. Egger's publication bias plot of the studies assessing progesterone receptor expression and disease-free survival/progress-free survival/recurrence-free survival of ovarian cancer patients. Visual inspection of the Egger's funnel plot did not indicate substantial asymmetry.