Expression And Clinical Significance Of HIF-1α In Cervical Cancer: A Systematic Review

Objective:To systematically review the correlation between the expression of HIF-1α and cervical cancer, as well as its clinically pathologic features.Methods:Systematic and comprehensive literature was searched in The Cochrane Library(Issue 3,2014), Pub Med, MEDLINE(Ovid), EMbase, CNKI, CBM and Wan Fang Data from inception to July 2014, to retrieve case-control studies published in the foreign and domestic areas on the correlation between the expression of HIF-1α and cervical cancer and its clinical pathologic features.Independently screened literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality of the included studies. Then meta-analysis was conducted using Rev Man 5.2 software.Results:A total of 13 studies involving 1309women(758 cervical cancer patients, 323 cervical intraepithelial neoplasis(CIN), 228 normal cervical. The results of meta-analysis showed that,a) as for the positive rate of HIF-1α expression, significant differences were found between cervical cancer and CIN [ OR=4.49, 95%CI(3.22,6.08), P<0.00001, cervical cancer and normal cervical tissues[OR=25.69, 95%CI(15.42,42.80), P<0.00001]and CIN and normal cervical tissues[OR=6.00, 95%CI(3.48,10.34), P<0.00001]. b) Significant differences were found between FIGO stagesⅠ- Ⅱand FIGO stages Ⅲ- Ⅳ(OR=0.15, 95%CI 0.08 to 0.29,P<0.0001), cervical cancer with lymph node metastasis and that without lymph node metastasis(OR=6.82, 95%CI 4.16 to 11.19, P<0.00001), moderate/low and high differentiated tumor tissues(OR=4.06, 95%CI 2.59 to 6.34, P<0.00001),tumor size≥4cm and tumor size<4cm(OR=4.27 95%CI 2.24 to 8.14, P<0.0001).No significant difference was found between cervical cancer with Squamous cell carcinomas and adenocarcinoma(OR=1.10,95%CI 0.42 to 2.86,P=0.85).Conclusions:Current foreign and domestic evidence shows that the HIF-1α expression of cervical cancer is higher than cervical intraepithelial neoplasis and normal cervical tissues, and HIF-1αexpression is significantly correlated to FIGO stages、lymph node metastasis、moderate、tumor size, and it is not significantly correlated to pathologic types.HIF- 1α positive expression rate with lymph node metastasis of Cervical cancer is higher than without lymph node metastasis of cervical cancer, this means that HIF- 1α associates with the metastasis of cervical cancer.It is becom more and more attention about the HIF- 1α expression in the tumor pathology, and the high expression of HIF- 1a predicts that tumors have higher aggressive.Detection of HIF-1a expressed in cervical cancer tissue can diagnose the malignant degree of tumor and provide important reference to evaluate prognosis.In this evaluation system, plenty of databases at home and abroad are retrieved and a perfect retrieval strategy is established. Due to the quality limitation of the included studies, more large scale,well-designed and high quality studies are needed for further verifying the aforementioned conclusion.