Abstract
BackgroundThe prognostic significance of survivin for survival of patients with esophageal squamous cell carcinoma (ESCC) remains controversial. Thus, meta-analysis of the literatures was performed in order to demonstrate its expression impact on ESCC clinicopathological features and prognosis.MethodologyRelevant literatures were searched using PubMed, EMBASE and Medline Databases. Revman5.0 software was used to pool eligible studies and summary hazard ratio (HR). Correlation between survivin expression and clinicopathological features of ESCC was analyzed.Principal FindingsFinal analysis of 523 patients from 7 eligible studies was performed. Combined HR of survivin location in nuclei suggested that survivin expression has an unfavorable impact on ESCC patients' survival (n = 277 in 3 studies; HR = 1.89, 95% CI: 1.45–2.96; Z = 4.69; P<0.0001). Nevertheless, combined HR of survivin location in cytoplasm displayed that survivin expression has no significance for prognosis of ESCC patients (n = 113 in 2 studies; HR = 0.96, 95% CI: 0.96–5.69; Z = 0.04; P = 0.97); Combined odds ratio (OR) of survivin location in cytoplasm indicated that survivin expression is associated with ESCC advanced stage (n = 113 in 2 studies; OR = 0.36, 95% CI: 0.14–0.93; Z = 2.10; P = 0.04). Whereas, combined OR of survivin location in nuclei exhibited that survivin over-expression has no correlation with cell differentiation grade, lymph node status, depth of invasion, stage, and metastasis of ESCC.ConclusionsThis study showed that survivin expression detected by immunohistochemistry seems to be associated with a worse prognosis of ESCC patients. Survivin subcellular location may be an important factor impacting on ESCC development. Larger prospective studies should be performed to evaluate the status of survivin in predicting prognosis of patients with ESCC.
Highlights
Esophageal squamous cell carcinoma (ESCC) is the leading cause of cancer death worldwide
This study showed that survivin expression detected by immunohistochemistry seems to be associated with a worse prognosis of esophageal squamous cell carcinoma (ESCC) patients
The study included in our meta-analysis should meet the following inclusion criteria as follows: (1) survivin expression evaluated in the primary ESCC tissues; (2) relationship demonstrated between survivin expression and ESCC clinicopathological parameters or prognosis; (3) survivin expression examined by immunohistochemistry; (4) articles published as a full paper in English; (5) studies provided sufficient information to estimate hazard ratio (HR) and 95% confidence interval (CI); (6) If multiple studies investigated the same patients or potential overlapping patients, only the most complete single study was selected
Summary
Esophageal squamous cell carcinoma (ESCC) is the leading cause of cancer death worldwide. The prognosis of ESCC patients is still poor and the 5-year overall survival (OS) rate is only 20% to 30% [1]. It is very important to search for biological markers, which can diagnose cancer as early as possible, estimate reaction to chemotherapy or radiotherapy in those patients with ESCC, and predict OS of patients undergoing treatment. An ideal tumor molecular marker can help us to assess prognosis and set up reasonable treatment. No specific molecular marker can be used in ESCC routinely. The prognostic significance of survivin for survival of patients with esophageal squamous cell carcinoma (ESCC) remains controversial. Meta-analysis of the literatures was performed in order to demonstrate its expression impact on ESCC clinicopathological features and prognosis
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