Clinical significance of B7-H4 expression in ovarian cancer: a meta-analysis ofproportions and time-to-event survival outcomes

B7-H4 is an immune-regulatory molecule increasingly recognized for its role in tumor progression and immune evasion in epithelial ovarian cancer. To clarify its clinical relevance, we conducted a systematic review and meta-analysis evaluating the prevalence of B7-H4 expression and its association with survival outcomes. Nineteen eligible studies were included, of which sixteen provided data on expression proportions and eight reported progression-free or overall survival outcomes. The pooled prevalence of high or positive B7-H4 expression was 73%, though with considerable inter-study variability. High B7-H4 expression was associated with a significantly increased risk of disease progression (pooled unadjusted hazard ratio: 1.43), while its relationship with overall survival remained inconclusive due to limited data. Despite methodological differences among studies, the findings suggest B7-H4 is overexpressed and potentially prognostic in ovarian cancer. Additional studies are required to validate its clinical utility in patient risk assessment and as a therapeutic target.