Prognostic and clinicopathological value of p53 expression in renal cell carcinoma: a meta-analysis

Background: The prognostic value of p53 expression in renal cell carcinoma (RCC) had been investigated in previous studies; however, the results remain inconsistent. This study was performed to investigate the prognostic and clinicopathological significance of p53 protein expression in RCC. Materials and Methods: Literature was identified from PubMed, Embase, Web of Science, and Cochrane database, which investigated the relationships between p53 expression and outcomes. Hazard ratios (HRs) for survival outcomes and odds ratios (ORs) for clinical parameters associated with p53 were extracted from eligible studies. Heterogeneity was assessed using the I-2 value. The fixed-effects model was used if there was no evidence of heterogeneity; otherwise, the random-effects model was used. Publication bias was evaluated using Begg's funnel plots and Egger's regression test. Results: A total of 2,013 patients from 22 studies were included in the meta-analysis. The results showed that p53 positive expression is associated with poor overall survival (OS) (HR = 2.17, 95% confidence [CI]: 1.51-3.13) and cancer-specific survival (CSS) (HR = 1.59, 95% CI: 1.19-2.12) in RCC. In addition, p53 positive expression was closely correlated with TNM stage (III/IV vs. I/II: OR = 2.51, 95% CI: 1.05-6.00), Fuhrman grade (III/IV vs. I/II: OR = 1.80, 95% CI: 1.24-2.63), and distant metastasis (M1 vs. M0: OR = 1.70, 95% CI: 1.16-2.49), but not related to lymph node involvement (N1 vs. N0: OR = 1.32, 95% CI: 0.80-2.18), primary tumor stage (pT3/pT4 vs. pT1/pT2: OR = 1.16, 95% CI: 0.88-1.53), and sex (n = 2, male vs. female, OR = 1.09, 95% CI: 0.70-1.68). Conclusions: This study suggests that p53 positive expression is correlated with poor prognosis and advanced clinicopathological features in patients with RCC, which indicates that p53 is a potentially effective therapeutic target.