Prognostic Value Of Mismatch Repair Gene In Women With Endometrial Cancer:A Meta Analysis

Objective:The aim of this study was to investigate the prognostic value of mismatch repair deficiency(dMMR)in endometrial carcinoma.Methods:We search for the literature database(PubMed,Embase,Cochrane Library)from January 1990 to December 2018.Study on the relationship between the status of MMR and the clinical outcome of endometrial carcinoma.We extracted the clinical outcome(OS or DFS)in each study and analyzed datas by the STATA 15.0 software.At the same time,the relationship between mismatch repair gene deletion and clinicopathological features was investigated.Results:26 studies met the inclusion criteria.The median sample size of the study was 178 cases,88%(23)was a retrospective case study,54%(14)evaluated the status of MMR by microsatellite instability(MSI)analysis.In50%(13)of the studies,immunohistochemical methods were used to assess the status of MMR.In the included study,54% of the studies showed asignificant association between dMMR and prognosis of endometrial carcinoma.There was significant inter-study heterogeneity between the HR values of OS and DFS.No significant association was found between dMMR and OS(16 studies,HR=1.40,95CI:0.93-2.10,P=0.103)or DFS(8studies,HR=1.74,95CI:0.81-3.72,p=0.153).Twenty-six studies met the inclusion criteria.The median sample size was 178.81%(21)of the studies were retrospective case studies.14 literatures evaluated MMR status by microsatellite instability(MSI),13 literatures assessed MMR status by immunohistochemical method,one literature did not provide a method for assessing MMR status and two of them detected MSI and MMR genes at the same time.Among the included studies,54%(14)of the studies showed that MMR deficiency was significantly associated with the prognosis of endometrial cancer.The HR values of OS and DFS showed significant inter-study heterogeneity.The combined analysis did not show any significant association between MMR deficiency and OS(16 studies,HR=1.40,95CI:0.93-2.10,P=0.103)or DFS(8 studies,HR=1.74,95CI:0.81-3.72,P=0.153).Conclusion:there is no clear evidence that there is a significant association between MMR status and prognosis of endometrial carcinoma.