Objective: Our primary objective was to evaluate the oncologic outcomes of patients with abnormal p53 FIGO grade 3 (high-grade) endometrioid endometrial cancer. As secondary objectives, we determined the global prevalence of abnormal p53 in grade 3 endometrioid endometrial carcinomas and the geographical variations. Methods: The following electronic databases were searched: PubMed/Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. We followed the Meta-Analysis for Observational Studies in Epidemiology guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This review was preregistered with PROSPERO (no: CRD42023495192). Bias was assessed using the Quality in Prognosis Studies tool. For time-to-event data, the effect of p53 status on grade 3 endometrial cancer was described using hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Overall survival and progression-free survival were analyzed using one- and two-stage approaches, the Kaplan–Meier method, and Cox proportional hazards models. Results: Fifty-seven studies with 2528 patients were included. Patients with abnormal p53 had an increased risk of death (HR, 1.29 (95% CI, 1.11–1.48); I2= 88%) and disease progression (HR, 1.63; 95% CI, 1.42–1.88; I2= 2%) compared with patients with wildtype p53 G3 endometrial cancer. The global pooled prevalence of abnormal p53 was 30% (95% CI, 25–34%; tau2= 0.02; I2= 74%), with the highest prevalence being found in studies conducted in Asia (95% CI, 27–41%; tau2= 0.01; I2= 52%). Conclusions: Abnormal p53 grade 3 endometrioid endometrial cancer is more common in Asia, and it is associated with decreased overall survival and progression-free survival.
目的：本研究的主要目的是评估p53异常的国际妇产科联盟（FIGO）3级（高级别）子宫内膜样子宫内膜癌患者的肿瘤学结局。次要目标包括确定3级子宫内膜样子宫内膜癌中p53异常的全球患病率及其地理分布差异。方法：检索了以下电子数据库：PubMed/Medline、EMBASE、Cochrane Library、Scopus和Web of Science。研究遵循流行病学观察性研究荟萃分析指南及系统综述与荟萃分析优先报告规范。本综述已在PROSPERO平台预注册（编号：CRD42023495192）。采用预后研究质量评估工具进行偏倚风险评估。针对时间-事件数据，使用风险比及其95%置信区间描述p53状态对3级子宫内膜癌的影响。通过单阶段与两阶段分析法、Kaplan-Meier法及Cox比例风险模型分析总生存期和无进展生存期。结果：共纳入57项研究，涉及2528例患者。与p53野生型3级子宫内膜癌患者相比，p53异常患者的死亡风险（HR=1.29，95% CI：1.11-1.48；I²=88%）和疾病进展风险（HR=1.63，95% CI：1.42-1.88；I²=2%）显著增高。全球p53异常汇总患病率为30%（95% CI：25-34%；τ²=0.02；I²=74%），其中亚洲地区研究报告的患病率最高（95% CI：27-41%；τ²=0.01；I²=52%）。结论：p53异常的3级子宫内膜样子宫内膜癌在亚洲更为常见，且与总生存期和无进展生存期降低显著相关。
Abnormal p53 High-Grade Endometrioid Endometrial Cancer: A Systematic Review and Meta-Analysis
肿瘤(癌症)患者之家