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. 2017 May 29;8(37):62400-62413.
doi: 10.18632/oncotarget.18253. eCollection 2017 Sep 22.

Correlation between estrogen receptor expression and prognosis in epithelial ovarian cancer: a meta-analysis

Zhaojun Shen  1 , Hui Luo  1 , Saisai Li  1 , Bo Sheng  1 , Menghuang Zhao  1 , Haiyan Zhu  1 , Xueqiong Zhu  1
Affiliations

Correlation between estrogen receptor expression and prognosis in epithelial ovarian cancer: a meta-analysis

Zhaojun Shen et al. Oncotarget. .

Abstract

Objective: Accumulated studies have investigated the prognostic significance of estrogen receptor expression in epithelial ovarian cancer, but results remain controversial. The aim of this study was to perform a meta-analysis to clarify the prognostic value of estrogen receptor expression in epithelial ovarian cancer.

Methods: A systematic search was performed in PUBMED, EMBASE, and COCHRANE databases to identify relevant studies up to December 2016. The pooled hazard rates (HR) with 95% confidence intervals (CIs) for overall survival and time to tumor progression were calculated and then weighted and pooled in this meta-analysis with a random-effect model.

Results: Thirty-five studies with a total of 5824 patients were included. In brief, the expression of estrogen receptor was associated with an improved overall survival (HR = 0.86, 95% CI = 0.76-0.97), whereas there was no significant difference between estrogen receptor and time to tumor progression among epithelial ovarian cancer patients. Subgroup analysis revealed that estrogen receptor expression was significantly correlated with overall survival in different subgroups, such as in unclassified epithelial ovarian cancer (HR= 0.80, 95% CI = 0.66-0.95), studies using immunohistochemistry detection method (HR= 0.85, 95% CI = 0.73-1.00), European population (HR= 0.75, 95% CI = 0.60-0.94) and estrogen receptor α subtype (HR= 0.78, 95% CI = 0.62-0.98).

Conclusions: Estrogen receptor, especially estrogen receptor α, was associated with an improved overall survival in epithelial ovarian cancer. Estrogen receptor expression may be a promising prognostic factor in epithelial ovarian cancer patients.

Keywords: epithelial ovarian cancer; estrogen receptor; meta-analysis; prognosis.

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Conflict of interest statement

CONFLICTS OF INTEREST No potential conflicts of interest were disclosed.

Figures

Figure 1
Figure 1. Flow of study identification, inclusion, and exclusion
Figure 2
Figure 2. Forest plot of HR and 95% CI in the meta-analysis of the association between estrogen receptor expression and overall survival of ovarian cancer patients
Summary of 35 studies, the results showed estrogen receptor was associated with a favorable overall survival of ovarian cancer using random effects model. The % weight was computed automatically by the Stata software.
Figure 3
Figure 3. Subgroup analysis of the association between estrogen receptor expression and overall survival of ovarian cancer
Figure 4
Figure 4. Forest plot of HR and 95% CI in the meta-analysis of the association between estrogen receptor expression and time to tumor progression of ovarian cancer patients
Summary of 18 studies, the results showed estrogen receptor was not associated with time to tumor progression of ovarian cancer using random effects model.
Figure 5
Figure 5. Subgroup analysis of the association between estrogen receptor expression and time to tumor progression of ovarian cancer
Figure 6
Figure 6
(A) Begg's funnel plots for the studies involved in the meta-analysis of estrogen receptor expression and overall survival of ovarian cancer patients. (B) Begg's funnel plots for the studies involved in the meta-analysis of estrogen receptor expression and time to tumor progression of ovarian cancer patients. Visual inspection of the Begg’s funnel plot did not indicate substantial asymmetry.
Figure 7
Figure 7
(A) Sensitivity analysis of the association between estrogen receptor expression and overall survival in ovarian cancer patients. (B) Sensitivity analysis of the association between estrogen receptor expression and time to tumor progression in ovarian cancer patients. The leave-one-out method was used to confirm the stability of the results.
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