Purpose: 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).
Conclusion: MMP-2 positivity in tumor cells is associated with worse survival in patients with gynecological cancers. Standardization of MMP positivity is needed.