1. ¹Fonds National de la Recherche Scientifique, Bruxelles, Belgium
2. ²Département de Médecine Interne et Laboratoire d'Investigation Clinique et d'Oncologie Expérimentale HJ Tagnon, Institut Jules Bordet, 1, rue Héger Bordet, 1000-Bruxelles, Belgium
3. ³Data Centre, Institut Jules Bordet, Bruxelles, Belgiuml
4. ⁴Service d'Anatomo-Pathologie, Institut Jules Bordet, Bruxelles, Belgium
5. ⁵Service de Pneumologie et d'Oncologie Thoracique, CHU Calmette, Lille, France

Correspondence: Dr AP Meert, Département de Médecine Interne et Laboratoire d'Investigation Clinique et d'Oncologie Expérimentale HJ Tagnon, Institut Jules Bordet, 1, rue Héger Bordet, 1000-Bruxelles, Belgium. E-mail: ap.meert@bordet.be

Received 24 March 2003; Revised 24 June 2003; Accepted 8 July 2003.

Abstract

C-erbB-2 prognostic value for survival in patients with lung cancer remains controversial. We performed a systematic review of the literature to clarify its impact. Studies were identified by an electronic search in order to aggregate the survival results, after a methodological assessment using the scale of the European Lung Cancer Working Party. To be eligible, a study had to deal with c-erbB-2 assessment in lung cancer patients and to analyse survival according to c-erbB-2 expression. In total, 30 studies were eligible: 24 studies dealt with non-small-cell lung carcinoma (NSCLC), five with adenocarcinoma and one study dealt with small-cell carcinoma. In all, 31% of the patients were positive for c-erbB-2. According to c-erbB-2 expression, 13 studies were 'negative' (significant detrimental effect on survival), one 'positive' (significant survival improvement) and 16 not significant. Significant studies had a better subscore relative to analysis and results report than nonsignificant studies. In total, 86% of the significant studies and only 56% of the nonsignificant studies were evaluable for the meta-analysis. This suggests a possible bias in our aggregated results. For NSCLC, the hazard ratio was 1.55 (95% CI: 1.29–1.86) in favour of tumours that do not express c-erbB-2. In conclusion, the overexpression of c-erbB-2 might be a factor of poor prognosis for survival in NSCLC, but there is a potential bias in favour of the significant studies with an overestimation risk of the magnitude of the true effect of c-erbB-2 overexpression.