| Objective:The effects of CALR and JAK2 gene mutations on the clinical features and prognosis of patients with PMF were systematically evaluated.Methods:Search the Chinese and English databases of The Cochrane Library,Pubmed,Embase,China Journal Full-text Database(CNKI),Chinese Science and Technology Periodical Database(WIP),China Biomedical Abstracts(CBM),Wanfang Data Knowledge Service Platform(Wanfang),and search The time limit is from the self-built library to December 2018,and all relevant documents published at home and abroad are obtained,and the languages are limited to Chinese and English.All retrieved literature was screened strictly according to inclusion and exclusion criteria and included in the clinical features of patients with primary myelofibrosis: gender,age,white blood cell count,hemoglobin level,platelet count,splenomegaly,thrombosis,leukemia transformation,and An observational study of overall survival.The Stata15 software was used to evaluate and analyze the observed indicators,and the odds ratio(OR)of the splenomegaly,thrombosis rate,and leukemia conversion rate,and the 95% confidence interval and the overall survival rate of the patients were calculated for CALR and JAK2 mutations.HR)and its 95% confidence interval.The Begg’s test was used to quantify the publication bias of the two-category data-level total survival data.The difference was statistically significant with P ≤ 0.05.Results:A total of 14 domestic and international observational studies were performed,including a total of 2095 patients,533 patients(25.4%)in the CALR mutation group,and 1562 JAK2 mutation patients(74.6%),which were included in the study of patients with two mutation types of PMF.There is no cross between them.A total of 7 studies reported the incidence of splenomegaly at the time of initial diagnosis,7 reported the rate of thrombosis,6 reported the conversion rate of acute myeloid leukemia,and 5 studies reported the risk ratio of overall survival during follow-up.(1)JAK2 mutant PMF patients are older than CALR mutant patients,with high male prevalence,high white blood cell count,low hemoglobin levels,and low platelet count;(2)The incidence of splenomegaly: meta-analysis showed that the incidence of splenomegaly in PLF patients with CALR mutation was 68.0%,and that in patients with JAK2 mutation was 83%.It was not shown that CALR and JAK2 mutations were associated with splenomegaly risk in PMF patients(OR=0.95 95 % CI 0.79-1.14,P>0.05);(3)thrombosis Formation rate: CALR gene mutation thrombosis rate 10%,JAK2 gene mutation was 17%,CALR mutation PMF patients with low risk of thrombosis(OR=0.65 95% CI0.42-1.00,P=0.05);(4)leukemia conversion rate : CALR mutant AML conversion rate of 10%,JAK2 was 9%,the combined OR of the two groups was 1.06(95% CI 0.71-1.58,P>0.05),did not indicate that the two groups of mutations are related to the risk of AML transformation in PMF patients;(5)Overall survival: Meta-analysis showed that the overall survival rate of patients with JAK2 mutant PMF was lower than that of patients with CALR mutations,and the combined risk ratio(HR)was 2.77(95% CI 1.71-4.47,P<0.05).Conclusion:Patients with JAK2 mutations have higher age and higher male prevalence,higher white blood cell counts,lower hemoglobin levels,and lower platelet counts than patients with CALR mutations;CALR mutations have a lower incidence of splenomegaly than patients with CALR mutations Patients with JAK2 mutations,but these two gene mutations were not associated with the risk of splenomegaly in patients with PMF;patients with CALR mutations had lower risk of thrombosis than patients with JAK2 mutations;patients with CALR mutations had higher AML conversion rates than JAK2,and did not show The risk of leukemia transformation is associated with PMF patients;the overall survival rate of patients with CALR mutations in PMF is higher than in patients with JAK2 mutations. |
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