Association between vascular endothelial growth factor expression and lymph node metastasis in cervical cancer: A meta-analysis

Aim: The expression of vascular endothelial growth factor (VEGF) by cancer cells has been identified as a factor that is associated with lymph node metastasis (LNM) in some cancers, but an accurate description of the relation between VEGF and LNM in cervical cancer is lacking. We conducted a concurrent meta-analysis to investigate this issue. Methods: We searched PubMed and EMBASE for articles addressing the association between VEGF and cervical cancer. We used STATA 12.0 and calculated the crude odds ratios (OR) and corresponding 95% confidence intervals (CI). Heterogeneity between the studies included was assessed by Cochran's Q-test. Results: Overall, 16 relevant studieswith 426 cases and 751 controlswere included in our study. The results demonstrated that cervical cancer patientswith VEGF-positive expression had a 2.87-fold higher risk of LNMthan patients without VEGF-positive expression (95% CI = 1.85-4.44, P < 0.001). Furthermore, subgroup analysis by ethnicity revealed that VEGF-positive expression could increase the risk of LNM in cervical cancer among Asian populations (OR = 2.55, 95% CI = 1.61-4.03, P< 0.001) and Caucasian populations (OR = 8.81, 95% CI = 2.78-27.88, P < 0.001). Moreover, subgroup analysis by country revealed that VEGF-positive expression could increase the risk of LNM in cervical cancer among Chinese populations (OR = 3.38, 95% CI = 2.18-5.25, P < 0.001) but not among Korean populations (P = 0.84) or Japanese populations (P = 0.06). Subgroup analysis based on sample size proved that VEGF-positive expression was statistically associated with LNM in a large sample group. Conclusion: Our study revealed that VEGF-positive expression is related with higher risk of LNM in cervical cancer.