| Objective:Using the systematic review and meta-analysis method to make a comprehensive qualitative and quantitative analysis of previous cohort studies, Evaluation of the distribution of HER-2 expression in gastric carcinoma and its influence in patients with gastric carcinoma.Method:According to the purpose of the study, the appropriate inclusion and exclusion criteria was conducted on the basis of research type, research object, expression of HER-2 and survival following up outcome indicators, then formulate a detailed search strategies, We searched PubMed, EMBASE, the Cochrane Library, CNKI, WANFANG, CBM, VIP Database, from January 1990 to December 2014 in published literature. Newcastle-Ottawa scale (The Newcastle-Ottawa Scale, NOS)was used to assess the quality of the eligible literature, two reviewers independently screened the studies for eligibility. Establish data collection form, collect the statistical effect of HER-2 expression on survival after gastric cancer surgery, HER-2 distribution and clinical pathology feature relations and other related data, survival data (OS,PFS)with HR as the test effect index, count data expression of HER-2 distribution and the clinicopathological features of gastric carcinoma with RR as a statistical quantity. Statistical analysis was performed by the RevMan5.3 software of Cochrane Collaboration, evaluation of statistically significant with the 95% confidence interval (CI), A two-sided P<0.05 was considered significant.A test for heterogeneity by chi square test, the test level is 0.1, p<0.1 was considered significant, using I2 statistics on the heterogeneity of the quantitative analysis, when I2 is greater than 50% that there is a high heterogeneity. Heterogeneity test results of p>0.1,12<50% identified as a heterogeneity without statistical significance among studies. Subgroup analysis as well as randomized effect model will be used to solve those with heterogeneity (p<0.1, I2>50%), The outcomes described by forest plot (Forest plot).Statistical analysis was performed by the STATA12.0 software to assess publication bias with Begg’s and Egger’s test.Results:26 research literatures were included, a retrospective cohort analysis of 25 literatures, prospective cohort of 1 literature, a total of 6529 cases, the male to female ratio 1.86, Median age 63.5 years, distribution area has a total of 22 countries in Asia, Europe Published since January 1990 to December 2014.Univariables analysis of The expression of HER-2 in gastric carcinoma and five year survival rate included 21 papers, according to HER-2 positive and negative groups, with five year survival of HR as index, the results show the HR1.75 (95%CI:1.40,2.19), gastric cancer patients with positive HER-2 have a poor prognosis.Subgroup analyses were performed separately (subgroup according to the stage of disease, HER-2 detection method, mode of operation, research area, research time), results suggest that over expression of HER-2 in gastric carcinoma had poor prognosis, different stage of gastric carcinoma and HER-2 detection method may be the sources of heterogeneity.8 articles provides the results of multivariate analysis, the heterogeneity between studies was statistically significant (p=0.0007,I2=64%), using a random effects model, the analysis results HR1.63 (95%CI:1.14,1.33), exposure to HER-2 positive was associated with a poor prognosis in gastric cancer patients.Relationship between HER-2 expression and clinical pathology of gastric cancer, the statistical results show that late tumor stage RR1.43(95%CI:1.19,1.72), tumor infiltrating deeper RR1.40 (95%CI: 1.08,1.82), Lauren’s intestinal type RR3.86 (95%CI:2.29,6.52), lymph node involvement RR1.41(95%CI:1.18,1.70)and vascular invasion RR1.87 (95%CI:1.11,3.16) accompanied by the existence of HER-2 over expression. Expression of HER-2 in better differentiation tumor is higher than that of poor differentiation tumors RR=0.60 (95%CI:0.43, 0.86).Conclusion:1. The prognosis of gastric carcinoma is influenced by many factors, over expression of HER-2 is poor prognosis in gastric carcinoma.2.1n the late stage of tumor, tumor infiltrating deeper, intestinal type of gastric cancer, lymph node and vascular involvement cases with higher HER-2 over expression rate.3.In this study, because of the trials is mainly the retrospective analysis of the queue, heterogeneity and bias cannot avoid completely, more high quality clinical research should involve to assess the prognostic significance of her-2 in gastric carcinoma. |
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