High hypoxia inducible factor-1α expression is associated with reduced survival in patients with breast cancer: A...

Hypoxia-inducible factor 1α (HIF-1α) plays a crucial role in the prognosis of breast cancer, but the current evidence remains inconclusive.

To provide comprehensive evidence about the correlation of altered HIF-1α expression with overall survival (OS) and disease-free survival (DFS) in breast cancer patients.

A systematic search was conducted in PubMed, Embase, and Web of Science databases to collect relevant articles that were published before April 8, 2024. A meta-analysis was used to assess the impact of altered HIF-1α expression on the OS and DFS of breast cancer patients. Subgroup and sensitivity analyses were also performed in this meta-analysis.

This meta-analysis included 40 studies. The average percentage of breast cancer patients with high HIF-1α expression was 39.6%. The overall meta-analysis results demonstrated that high HIF-1α expression is strongly linked to poor outcomes in patients of breast cancer. Compared with low HIF-1α expression, the overall hazard ratio for OS in patients with high HIF-1α expression was 1.47 [95% confidence interval (CI): 1.29-1.69], and the overall hazard ratio for DFS was 1.82 (95%CI: 1.56-2.12). Furthermore, both OS [1.18 (95%CI: 1.01-1.38)] and DFS [1.79 (95%CI: 1.03-3.11)] were markedly shorter in triple-negative breast cancer cases with high HIF-1α expression. Subgroup analysis revealed that the antibody used to detect HIF-1α expression affected only the correlation linking HIF-1α expression to DFS in breast cancer patients (P = 0.0004). Furthermore, the sensitivity analysis demonstrates that the overall conclusions of the meta-analysis were unaffected by the removal of individual studies.

Compared to patients with low HIF-1α expression, those with high expression level had shorter OS and DFS. However, the prognostic significance of high HIF-1α expression varies across molecularly stratified breast cancer cohorts needs to be further elucidated.