Prognostic role of hormone receptors in endometrial cancer: a systematic review and meta-analysis

BACKGROUND The aim of this study was to summarize the global predicting role of hormone receptors for survival in endometrial cancer. METHODS Eligible studies were identified and assessed for quality through multiple search strategies. Data were collected from studies comparing overall survival (OS), cancer-specific survival (CSS), or progression-free survival (PFS) in patients with elevated levels of estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) with those in patients with lower levels. The combined hazard ratios of ER, PR, and HER2 for survival were calculated. RESULTS A total of 98 studies were included for meta-analysis (44 for ER, 38 for PR, and 16 for HER2). Higher levels of either ER or PR could significantly indicate better survival. The pooled hazard ratios (HRs) of ER for OS, CSS, and PFS were 0.75 (95% CI, 0.68-0.83), 0.45 (95% CI, 0.33-0.62), and 0.66 (95% CI, 0.52-0.85), respectively. The combined HRs of PR for OS, CSS, and PFS reached 0.63 (95% CI, 0.56-0.71), 0.62 (95% CI, 0.42-0.93), and 0.45 (95% CI, 0.30-0.68), respectively. In contrast, elevated levels of HER2 could predict worse outcome with a HR of 1.98 (95% CI, 1.49-2.62) for OS, and a HR of 2.26 (95% CI, 1.57-3.25) for PFS. CONCLUSIONS In patients with endometrial cancer, higher level of ER and PR predicted favorable survival, and increased level of HER2 was associated with poorer survival. All of the three hormone receptors had prognostic value for survival.