Proliferating Cell Nuclear Antigen (PCNA) Expression in Nasal Polyps: A Systematic Review and Meta-analysis

Proliferating Cell Nuclear Antigen (PCNA) Expression in Nasal Polyps: A Systematic Review and Meta-analysis
Masood Soltanipur,^1,* Alireza Shadmand,² Mohammadreza Karimi Nemch,³ Hossein Yarmohammadi,⁴ Seyed Davar Siadat,⁵ Mohammadreza Jalali Nadoushan,⁶
1. Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
2. Faculty of Economics and Social Sciences, Heidelberg University, Heidelberg, Germany
3. Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
4. Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
5. Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
6. Department of Pathology, Faculty of Medicine, Shahed University, Tehran, Iran.
Introduction: Nasal polyps (NP) are benign growths occurring in the nasal cavity and paranasal sinuses, often linked with chronic rhinosinusitis (CRS), specifically termed chronic rhinosinusitis with nasal polyps (CRSwNP). Proliferating cell nuclear antigen (PCNA) serves as a marker for abnormal cell proliferation, which can be valuable for evaluating nasopharyngeal lesions and upper airway cancers. This study investigates the expression of PCNA in NP tissue.
Methods: This study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A thorough search using relevant keywords was performed on the electronic database to identify studies examining the PCNA expression in NP. A meta-analysis was performed using the metamean and metaprop functions in R software (version 4.4.0) to analyze pooled data on PCNA expression. Quality assessments were based on the Joanna Briggs Institute (JBI) checklist.
Results: The analysis included ten articles. Findings indicated that PCNA expression in NP was significantly higher than in normal nasal mucosa (NNM) but lower than in inverted papilloma (IP). The mean percentage of PCNA expression in NP was 15.73% (95%-CI [2.87-28.58]), with substantial heterogeneity (I²=97%, p<0.01). Using a cutoff of >5% staining, 64% of NP samples were found to be PCNA-positive (95%-CI [42%-81%]), exhibiting high heterogeneity (I²=76%, p<0.01).
Conclusion: The study concludes that NP tissue exhibits a relatively high expression of the PCNA oncoprotein based on immunohistochemistry (IHC) staining. Despite over half of the NP samples testing positive for PCNA, the average expression level remains lower than that observed in IP tissue.
Keywords: Nasal polyp; NP; Nasal polyposis ; Proliferating Cell Nuclear Antigen; PCNA