title: Prognostic value and clinicopathological significance of proliferating cell nuclear antigen expression in gastric cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  The prognostic significance of proliferating cell nuclear antigen (PCNA) expression in gastric cancer has long been assessed, yet results remain controversial. Therefore, we performed a meta-analysis to assess the prognostic value and clinicopathological significance of PCNA in gastric cancer.
  
  
  METHODS
  A systematic literature search of PubMed, EMBASE, and the Cochrane Library databases was conducted. Summary odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to investigate the correlations between PCNA expression and clinicopathological features, overall survival (OS), and disease-free survival (DFS).
  
  
  RESULTS
  A total of 19 studies involving 2,852 participants were included in our analysis. The pooled HR indicated that high PCNA expression was significantly associated with poor OS (HR 1.66, 95% CI 1.32-2.08) and DFS (HR 1.81, 95% CI 1.40-2.36). Subgroup analysis revealed that the association between PCNA and OS was also significant in Asian and European patients. In addition, the pooled ORs showed that high PCNA expression was significantly associated with deeper tumor invasion (OR 2.37, 95% CI 1.71-3.27), lymph node metastasis (OR 2.49, 95% CI 1.85-3.35), and advanced stage cancer (OR 1.89, 95% CI 1.36-2.63).
  
  
  CONCLUSIONS
  Our meta-analysis indicates that high PCNA expression might be a prognosticator of poor survival and a promising therapeutic target for gastric cancer patients.
authors.affiliation: Department of Surgical Oncology.
authors.forename: Songcheng
authors.initials: S
authors.lastname: Yin
authors.affiliation: Department of Breast Surgery, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Surgical Oncology.
authors.forename: Jinyu
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Surgical Oncology.
authors.forename: Zhifeng
authors.initials: Z
authors.lastname: Miao
authors.affiliation: Department of Surgical Oncology.
authors.forename: Junyan
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Surgical Oncology.
authors.forename: Chunyang
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Surgical Oncology.
authors.forename: Hao
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Surgical Oncology.
authors.forename: Huimian
authors.initials: H
authors.lastname: Xu
keywords: biomarker; gastric cancer; meta-analysis; prognosis; proliferating cell nuclear antigen