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Prognostic Value of Survivin in Patients with Gastric Cancer: A Systematic Review with Meta-Analysis

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  • Jin Long Liu
  • Wei Gao
  • Qing Min Kang
  • Xue Jun Zhang
  • Shu Guang Yang

Abstract

Objective: The prognostic significance of survivin for the survival of patients with gastric cancer remains controversial. Thus, the objective of this study was to conduct a systematic review of the literature evaluating survivin expression in gastric cancer as a prognostic indicator. Methods: Relevant literature was searched using PubMed, EMBASE, and Chinese biomedicine databases. A meta-analysis of the association between survivin expression and overall survival in patients with gastric cancer was performed. Studies were pooled and summary hazard ratios (HRs) were calculated. Subgroup analyses were also conducted. Results: Final analysis of 1365 patients from 16 eligible studies was performed. Combined HR suggested that survivin expression had an unfavorable impact on survival of gastric cancer patients (HR=1.39, 95% CI: 1.16-1.68). The unfavorable impact also appeared significant when stratified according to the studies categorized by patients’ ethnicity, detection methods, type of sample, and HR estimate. The combined HR in the English literature showed an inverse effect on survival (HR=1.40, 95% CI: 1.13-1.75), while HR in the non-English literature did not (HR=1.38, 95% CI: 0.93-2.05). When stratified according to the location of survivin expression, combined HR showed that expression in cytoplasm was significantly associated with poor prognosis of gastric cancer patients (HR=1.46, 95% CI: 1.12-1.90). While expression in nucleus was not significantly associated with poor prognosis (HR=1.29, 95% CI: 0.72-2.31), the heterogeneity was highly significant (chi-squared=11.5, I2=74%, p=0.009). Conclusions: This study showed that survivin expression was associated with a poor prognosis in patients with gastric cancer. Cytoplasmic expression of survivin may be regarded as a prognostic factor for gastric cancer patients. In contrast, survivin expression in nucleus did not have a significant impact on patients’ overall survival.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0071930
    DOI: 10.1371/journal.pone.0071930
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    References listed on IDEAS

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    1. Chunguang Li & Zhigang Li & Maoling Zhu & Tiejun Zhao & Ling Chen & Weidan Ji & Hezhong Chen & Changqing Su, 2012. "Clinicopathological and Prognostic Significance of Survivin Over-Expression in Patients with Esophageal Squamous Cell Carcinoma: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 7(9), pages 1-7, September.
    2. Fengzhi Li & Grazia Ambrosini & Emily Y. Chu & Janet Plescia & Simona Tognin & Pier Carlo Marchisio & Dario C. Altieri, 1998. "Control of apoptosis and mitotic spindle checkpoint by survivin," Nature, Nature, vol. 396(6711), pages 580-584, December.
    3. 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.
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    1. Jing Chen & Tao Li & Qilun Liu & Haiyan Jiao & Wenjun Yang & Xiaoxia Liu & Zhenghao Huo, 2014. "Clinical and Prognostic Significance of HIF-1α, PTEN, CD44v6, and Survivin for Gastric Cancer: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-15, March.
    2. 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.
    3. Yong Huang & Huaiwei Liao & Yong Zhang & Rongfa Yuan & Fengmei Wang & Yingtang Gao & Peng Wang & Zhi Du, 2014. "Prognostic Value of Tumor-Infiltrating FoxP3+ T Cells in Gastrointestinal Cancers: A Meta Analysis," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-12, May.

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