Prognostic value of p53 expression in childhood nephroblastoma: a meta-analysis

Background: Nephroblastoma is a heterogeneous disease and the most common neoplasm of the kidney in children. The purpose of this study was to evaluate the prognostic value of tumor suppressor p53 expression in childhood nephroblastoma. Methods: Relevant studies published between January 2000 and 2015 were searched and retrieved using Medline, Web of science, PubMed and CNKI. The odds ratio (OR) and risk ratio (RR) with their 95% confidence interval (CI) were employed to calculate the strength of value. Results: Total 12 articles were finally screened out, including 415 children with nephroblastoma. Overall, our result detected that the frequency of p53 expression was much higher in advance stage (III+IV+V) than that in early stage (I-II) (53.9% versus 13.1%), and indicated that p53 expression was associated with tumor stages (OR=5.90, 95% CI=3.54-9.85, P<0.00001). Subgroup analysis by ethnicity showed that p53 expression increased the tumor risk in both Asian and non-Asian populations (P<0.00001). P53 expression was positively correlated with unfavorable histological type (OR=31.87, 95% CI=10.14-100.14, P<0.00001) as well. Furthermore, p53 expression increased the metastasis of nephroblastoma (OR=5.59, 95% CI=2.43-12.86, P<0.00001), and decreased the overall survival (RR=4.87, 95% CI=2.18-10.88, P=0.0001). No significant association was found between p53 expression and gender, recurrence and histological components of patients with nephroblastoma. Conclusions: Our results indicated that p53 expression could be used as an indicator to predict the poor prognosis and a reference index to determine the clinical stages and histological types of the tumor.