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Prognostic Role of Hormone Receptors in Ovarian Cancer: A Systematic Review and Meta-Analysis

Zhao, Dong MD*; Zhang, Fengmei BSc; Zhang, Wei BSc; He, Jing BSc; Zhao, Yulan MD, PhD; Sun, Jing MD*

International Journal of Gynecological Cancer: January 2013 - Volume 23 - Issue 1 - p 25–33
doi: 10.1097/IGC.0b013e3182788466

Objective: The aim of this study was to summarize the global predicting role of hormone receptors for survival in ovarian cancer.

Methods: Eligible studies were identified and assessed for quality through multiple search strategies. Data were collected from studies comparing overall or progression-free/disease-free/relapse-free survival 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. Studies were pooled, and combined hazards ratios (HRs) of ER, PR, and HER2 for survival were calculated, respectively.

Results: A total of 35 studies were included for meta-analysis (23 for ER, 19 for PR, and 8 for HER2). For overall survival, the pooled HR of PR reached 0.88 [95% confidence interval (CI), 0.82-0.95], which means that elevated PR level could significantly indicate better survival. In contrast, elevated levels of HER2 could predict worse outcome with an HR of 1.41 (95% CI, 1.05–1.89). Increased level of ER was not significantly prognostic (HR, 0.94; 95% CI, 0.87–1.01). For progression-free survival/disease-free survival/recurrence-free survival, elevated PR level also had predictive value for better outcome with a pooled HR of PR of 0.80 (95% CI, 0.67–0.95). Oppositely, elevated HER2 level could predict poorer outcome with an HR of 1.55 (95% CI, 1.11–2.16). Estrogen receptor failed to predict outcome with an HR of 0.90 (95% CI, 0.78–1.03).

Conclusions: In patients with ovarian cancer, elevated level of PR predicted favorable survival, and elevated level of HER2 was associated with worse survival.

*Department of Minimally Invasive Gynecologic Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine; and †Institutes for Advanced Interdisciplinary Research and ‡School of Life Science, East China Normal University, Shanghai, PR China.

Address correspondence and reprint requests to Jing Sun, MD, Department of Minimally Invasive Gynecologic Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040, PR China. E-mail:; Yulan Zhao, MD, PhD, School of Life Science, East China Normal University, N Zhongshan Rd 3663, Shanghai City, PR China, 200062. E-mail:

Dong Zhao and Fengmei Zhang contributed equally to this work.

The analysis was supported by the National Natural Science Foundation of China (NSFC 30800401) and Shanghai Rising star program (08QA1407000).

The authors declare no conflicts of interest.

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Received August 22, 2012

Accepted October 10, 2012

Copyright © 2013 by IGCS and ESGO