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Downregulated E-Cadherin Expression Indicates Worse Prognosis in Asian Patients with Colorectal Cancer: Evidence from Meta-Analysis

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  • Xin He
  • Zhigang Chen
  • Minyue Jia
  • Xiaoying Zhao

Abstract

Background: Epithelial-mesenchymal transition (EMT) plays a crucial role in the progression and aggressiveness of colorectal carcinoma. E-cadherin is the best-characterized molecular marker of EMT, but its prognostic significance for patients with CRC remains inconclusive. Methodology: Eligible studies were searched from the PubMed, Embase and Web of Science databases. Correlation between E-cadherin expression and clinicopathological features and prognosis was analyzed. Subgroup analysis was also performed according to study location, number of patients, quality score of studies and cut-off value. Principal Findings: A total of 27 studies comprising 4244 cases met the inclusion criteria. Meta-analysis suggested that downregulated E-cadherin expression had an unfavorable impact on overall survival (OS) of CRC (n = 2730 in 14 studies; HR = 2.27, 95%CI: 1.63–3.17; Z = 4.83; P = 0.000). Subgroup analysis indicated that low E-cadherin expression was significantly associated with worse OS in Asian patients (n = 1054 in 9 studies; HR = 2.86, 95%CI: 2.13–3.7, Z = 7.11; P = 0.000) but not in European patients (n = 1552 in 4 studies; HR = 1.14, 95%CI: 0.95–1.35, Z = 1.39; P = 0.165). In addition, reduced E-cadherin expression indicated an unfavorable OS only when the cut off value of low E-cadherin expression was >50% (n = 512 in 4 studies; HR = 2.08, 95%CI 1.45–2.94, Z = 4.05; P = 0.000). Downregulated E-cadherin expression was greatly related with differentiation grade, Dukes' stages, lymphnode status and metastasis. The pooled OR was 0.36(95%CI: 0.19–0.7, Z = 3.03, P = 0.002), 0.34(95%CI: 0.21–0.55, Z = 6.61, P = 0.000), 0.49(95%CI: 0.32–0.74, Z = 3.02, P = 0.002) and 0.45(95%CI: 0.22–0.91, Z = 3.43, P = 0.001), respectively. Conclusions: This study showed that low or absent E-cadherin expression detected by immunohistochemistry served as a valuable prognostic factor of CRC. However, downregulated E-cadherin expression seemed to be associated with worse prognosis in Asian CRC patients but not in European CRC patients. Additionally, this meta-analysis suggested that the negative threshold of E-cadherin should be >50% when we detected its expression in the immunohistochemistry stain.

Suggested Citation

  • Xin He & Zhigang Chen & Minyue Jia & Xiaoying Zhao, 2013. "Downregulated E-Cadherin Expression Indicates Worse Prognosis in Asian Patients with Colorectal Cancer: Evidence from Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-8, July.
    • Handle: RePEc:plo:pone00:0070858
    DOI: 10.1371/journal.pone.0070858
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    Cited by:

    1. Jiang Chen & Jie Zhao & Rui Ma & Hui Lin & Xiao Liang & Xiujun Cai, 2014. "Prognostic Significance of E-Cadherin Expression in Hepatocellular Carcinoma: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-8, August.
    2. Ning Wang & Yong-Lai He & Li-Juan Pang & Hong Zou & Chun-Xia Liu & Jin Zhao & Jian-Ming Hu & Wen-Jie Zhang & Yan Qi & Feng Li, 2015. "Down-Regulated E-Cadherin Expression Is Associated with Poor Five-Year Overall Survival in Bone and Soft Tissue Sarcoma: Results of a Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-12, March.

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