Prognostic and clinicopathological significance of glypican-3 overexpression in hepatocellular carcinoma: A meta-analysis

AIM:To investigate the prognostic and clinicopathological significance of glypican-3(GPC3)overexpression in hepatocellular carcinoma(HCC).METHODS:Publications were searched using PubMed,EMBASE,the Cochrane Library and the Chinese Biomedical Literature Database up to March 2013.Inclusion and exclusion criteria were established to screen eligible studies for meta-analysis.The hazard ratios(HRs)of the eligible studies were pooled using RevMan5.2 software to evaluate the impact of GPC3 overexpression on overall survival(OS)and disease-free survival(DFS)in HCC patients.The correlation between GPC3 expression and clinicopathological parameters of HCC was also analyzed.RESULTS:A total of five studies with 493 patients were included in the meta-analysis.The combined HRs indicated that GPC3 overexpression can predict poorOS(n=362 in 3 studies,HR=2.18,95%CI:1.47-3.24,Z=3.86,P=0.0001)and DFS(n=325 in 3 studies,HR=2.05,95%CI:1.43-2.93,Z=3.94,P<0.0001)in HCC patients without heterogeneity.Egger’s and Begg’s tests were applied to detect publication bias,and the results showed that there was no evidence of publication bias detected in the OS studies(the P value for Egger’s test was 0.216)or DFS studies(the P value for Egger’s test was 0.488).The combined odds ratios(ORs)suggested that GPC3 expression tends to be associated with tumor vascular invasion(OR=2.74,95%CI:1.15-6.52,P=0.02),hepatic cirrhosis(OR=2.10,95%CI:1.31-3.36,P=0.002),poor tumor differentiation(OR=0.22,95%CI:0.13-0.40,P<0.00001)and advanced TNM stage(OR=0.31,95%CI:0.18-0.51,P<0.00001).CONCLUSION:From this study,we conclude that GPC3 overexpression tends to be associated with a poor prognosis(poor OS or DFS)in HCC.