title: Prognostic significance of matrix metalloproteinase-2 in gynecological cancer: a systemic review of the literature and meta-analysis.
abstract: OBJECTIVE
  Matrix metalloproteinases (MMPs) are considered as mediators of metastases which may be associated with gynecological cancer survival. However, such relationship remains inconclusive. We carried out the present metaanalysis to evaluate the prognostic value of MMP-2 and MMP-9 in gynecological cancers.
  
  
  METHODS
  We searched 2 medical databases (Medline and Embase) and located 13 studies with 1841 patients that evaluated the relationship between MMP-2 and MMP-9 and 5-year survival. Risk ratio (RR) with 95% confidence intervals (95% CI) synthesized by random effect model were used to assess the strength of the association. Publication bias was evaluated by Begg-Mazumdar test and Egger's regression test.
  
  
  RESULTS
  Mortality was 1.53-fold higher in patients whose tumor cells were positive for MMP-2 (RR 1.53; 95% CI 1.03-2.27; p=0.03).Funnel plot was symmetrical (p=0.721 for Begg-Mazumdar test, and p=0.718 for Egger's regression test). Between-study heterogeneity was significant (p<0.001). Mortality was 1.26-fold higher in MMP-9 positive than negative patients, but without statistical difference (RR 1.26; 95% CI 0.94-1.68; p=0.12). Funnel plot was asymmetrical (p=0.024 for Begg-Mazumdar test).
  
  
  CONCLUSIONS
  MMP-2 positivity in tumor cells is associated with worse survival in patients with gynecological cancers. Standardization of MMP positivity is needed.
authors.affiliation: West China Second Hospital, Sichuan University, Chengdu, China. holyn.phang@gmail.com
authors.forename: Hongling
authors.initials: H
authors.lastname: Peng
authors.forename: Lei
authors.initials: L
authors.lastname: Liu
authors.forename: Xia
authors.initials: X
authors.lastname: Zhao
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis*; D005260:Female; D005833:Genital Neoplasms, Female / Q000201:enzymology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D020778:Matrix Metalloproteinase 2 / Q000032:analysis*; D020780:Matrix Metalloproteinase 9 / Q000032:analysis; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor; C522361:MMP2 protein, human; D020778:Matrix Metalloproteinase 2; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9