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Meta-Analysis
. 2023 Feb;307(2):379-386.
doi: 10.1007/s00404-022-06531-2. Epub 2022 Mar 28.

Diagnostic and prognostic value of Bcl-2 in uterine leiomyosarcoma

Antonio Travaglino  1 , Antonio Raffone  2   3 , Diego Raimondo  4 , Annarita Gencarelli  1 , Italia Esposito  5 , Cinzia Gallo  6 , Francesco Paolo Improda  5 , Salvatore Giovanni Vitale  7 , Antonio Mollo  8 , Paolo Casadio  4 , Renato Seracchioli  4 , Fulvio Zullo  5 , Luigi Insabato  1
Affiliations
Meta-Analysis

Diagnostic and prognostic value of Bcl-2 in uterine leiomyosarcoma

Antonio Travaglino et al. Arch Gynecol Obstet. 2023 Feb.

Abstract

Background: Uterine leiomyosarcoma (uLMS) may show loss of expression of B-cell lymphoma-2 (Bcl-2) protein. It has been suggested that Bcl-2 loss may both be a diagnostic marker and an unfavorable prognostic marker in uLMS.

Objective: To define the diagnostic and prognostic value of Bcl-2 loss in uLMS through a systematic review and meta-analysis.

Methods: Electronic databases were searched from their inception to May 2020 for all studies assessing the diagnostic and prognostic value of Bcl-2 loss of immunohistochemical expression in uLMS. Data were extracted to calculate odds ratio (OR) for the association of Bcl-2 with uLMS vs leiomyoma variants and smooth-muscle tumors of uncertain malignant potential (STUMP), and hazard ratio (HR) for overall survival; a p value < 0.05 was considered significant.

Results: Eight studies with 388 patients were included. Loss of Bcl-2 expression in uLMS was not significantly associated with a diagnosis of uLMS vs leiomyoma variants and STUMP (OR = 2.981; p = 0.48). Bcl-2 loss was significantly associated with shorter overall survival in uLMS (HR = 3.722; p = 0.006). High statistical heterogeneity was observed in both analyses.

Conclusion: Loss of Bcl-2 expression appears as a significant prognostic but not diagnostic marker in uLMS. The high heterogeneity observed highlights the need for further research and larger studies.

Keywords: Immunohistochemistry; Leiomyoma; Prognosis; Smooth-muscle tumor; bcl2.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Forest plot reporting odds ratio (OR) values with 95% confidence interval (CI), for each study and as pooled estimate, for the association of Bcl-2 loss of immunohistochemical expression with a diagnosis of uterine leiomyosarcoma vs leiomyoma variants and STUMP
Fig. 2
Fig. 2
Funnel plot of logarithm of odds ratio by standard error for the assessment of the risk of bias across studies (publication bias). The asymmetrical distribution of the primary studies suggests the possibility of a publication bias
Fig. 3
Fig. 3
Forest plot reporting hazard ratio (HR) values with 95% confidence interval (CI), for each study and as pooled estimate, for the association of Bcl-2 loss of immunohistochemical expression with the risk of death in uterine leiomyosarcoma
Fig. 4
Fig. 4
Funnel plot of logarithm of hazard ratio by standard error for the assessment of the risk of bias across studies (publication bias). The asymmetrical distribution of the primary studies suggests the possibility of a publication bias
See this image and copyright information in PMC

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