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Prognostic Value of Survivin in Patients with Non-Small Cell Lung Carcinoma: A Systematic Review with Meta-Analysis

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  • Lou Qian Zhang
  • Jun Wang
  • Feng Jiang
  • Lin Xu
  • Fu Yin Liu
  • Rong Yin

Abstract

Purpose: The potential prognostic value of survivin in resected non-small cell lung carcinoma (NSCLC) is variably reported. The objective of this study was to conduct a systematic review of literatures evaluating survivin expression in resected NSCLC as a prognostic indicator. Methods: Relevant literatures were identified using PubMed, EMBASE and Chinese Biomedicine Databases. We present the results of a meta-analysis of the association between survivin expression and overall survival (OS) in NSCLC patients. Studies were pooled and summary hazard ratios (HR) were calculated. Subgroup analyses and publication bias were also conducted. Results: We performed a final analysis of 2703 patients from 28 evaluable studies. Combined HRs suggested that survivin overexpression had an unfavorable impact on NSCLC patients' survival with no evidence of any significant publication bias (HR = 2.03, 95%CI: 1.78–2.33, Egger's test, P = 0.24) and no severe heterogeneity between studies (I2 = 26.9%). Its effect also appeared significant when stratified according to the studies categorized by histological type, HR estimate, patient race, cutoff point (5%, 10%), detection methods and literature written language except for disease stage. Survivin was identified as a prognostic marker of advanced-stage NSCLC (HR = 1.93, 95%CI: 1.49-2.51), but not early-stage NSCLC (HR = 1.97, 95%CI: 0.76-5.14), in spite of the combined data being relatively small. Conclusion: This study shows that survivin expression appears to be a pejorative prognostic factor in terms of overall survival in surgically treated NSCLC. Large prospective studies are now needed to confirm the clinical utility of survivin as an independent prognostic marker.

Suggested Citation

  • Lou Qian Zhang & Jun Wang & Feng Jiang & Lin Xu & Fu Yin Liu & Rong Yin, 2012. "Prognostic Value of Survivin in Patients with Non-Small Cell Lung Carcinoma: A Systematic Review with Meta-Analysis," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-9, March.
    • Handle: RePEc:plo:pone00:0034100
    DOI: 10.1371/journal.pone.0034100
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    References listed on IDEAS

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    1. Aurelio Tobias, 1999. "Assessing the influence of a single study in the meta-anyalysis estimate," Stata Technical Bulletin, StataCorp LLC, vol. 8(47).
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    1. Jin Long Liu & Wei Gao & Qing Min Kang & Xue Jun Zhang & Shu Guang Yang, 2013. "Prognostic Value of Survivin in Patients with Gastric Cancer: A Systematic Review with Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-1, August.
    2. Kuangguo Zhou & Danmei Xu & Yang Cao & Jue Wang & Yunfan Yang & Mei Huang, 2014. "C-MYC Aberrations as Prognostic Factors in Diffuse Large B-cell Lymphoma: A Meta-Analysis of Epidemiological Studies," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    3. Ke-yan Cheng & Zhi-lian Wang & Qian-yun Gu & Min Hao, 2016. "Survivin Overexpression Is Associated with Aggressive Clinicopathological Features in Cervical Carcinoma: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-15, October.
    4. Shang Xie & Hui Xu & Xiaofeng Shan & Baozhong Liu & Kan Wang & Zhigang Cai, 2015. "Clinicopathological and Prognostic Significance of Survivin Expression in Patients with Oral Squamous Cell Carcinoma: Evidence from a Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(2), pages 1-16, February.
    5. Jin Long Liu & Xue Jun Zhang & Zhao Zhang & An Hong Zhang & Wei Wang & Jia Hong Dong, 2013. "Meta-Analysis: Prognostic Value of Survivin in Patients with Hepatocellular Carcinoma," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-10, December.

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