Objective: Matrix metalloproteinase-9(MMP-9) plays an important role in tumor cell invasion. Althoughit has been studied frequently in ovarian cancer, its prognostic impact is still equivocal. The aim of this studywas to more precisely estimate its prognostic significance. Method:We searched Pubmed, Embase, OVID,Sciencedirect and CBM databases to identify eligible studies. Hazard ratios (HRs) or odds ratios (ORs) with 95%confidence intervals (95% CIs) were pooled across studies using fixed-effects or random-effects models. We alsoperformed subgroup analysis. Results: 30 studies (n=2552 patients) focusing on prognosis or expression of MM-9were included. Increased expression of MMP-9 was associated with poor prognosis in ovarian cancer patients(HR=1.68, 95%CI 1.09-2.59, p=0.02). Besides, MMP-9 expression in ovarian cancer was significantly higher thannon-malignant tumors (OR=11.46, 95%CI 8.47-15.50, P<0.00001). Moreover, increased expression of MMP-9was significantly associated with FIGO stage (OR=4.85, 95%CI 2.60-9.04, P<0.00001), grade of differentiation(OR=3.34, 95%CI 2.46-4.54, P<0.00001), lymph node metastasis (OR=5.75, 95%CI 3.71-8.92, P<0.00001) andthere was no association with histological type of ovarian cancer. Conclusions: Increased expression of MMP-9 was associated with poor prognosis in ovarian cancer patients. Down-regulation of MMP-9 is an attractivetherapeutic approach which might improve outcome of ovarian cancer.
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