The high expression instead of mutation of p53 is predictive of overall survival in patients with esophageal squamous-cell carcinoma: a meta-analysis

Esophageal squamous-cell carcinoma (ESCC) is one of the deadliest cancers where biomarkers are needed for assist guiding management. We performed a meta-analysis to clarify the prognostic value of p53 high expression and TP53 mutations, which remain controversial for decades in patients with ESCC. We searched PubMed, Ovid MEDLINE, Embase, and Current Contents Connect to identify studies published between January 1990 and February 2016 of esophageal cancer populations that measured p53 expression and/or mutation status and reported hazard ratios (HRs), or adequate data for estimation of HRs for survival for p53-defined subgroups. We calculated pooled HR and 95% confidence interval (CI) using a random-effects model. A total of 56 eligible studies including 6537 patients were identified. The p53 high expression was associated with reduced survival (HR: 1.35, 95% CI: 1.21-1.50, I-2=42%). In subgroup analyses, a greater prognostic effect was observed in those studies that reported survival for pure ESCC cohorts and were assessed at low risk of bias (HR: 1.46, 95% CI: 1.29-1.65, I-2=8%). Patients with ESCC and p53 high expression have reduced overall survival, and this effect is independent of tumor stage and greater than that of TP53 mutations.