Abstract
Survivin/BIRC5 is a potentially interesting prognostic marker and therapeutic target in colorectal cancer (CRC). However, the available data on survivin expression in CRC are heterogeneous. Thus, to clarify the prognostic relevance of survivin in patients with CRC and its association with clinicopathological parameters we performed a meta-analysis. We screened PubMed and EMBASE for those studies that investigated the prognostic value of survivin and its association with clinicopathological parameters in CRC. Data from eligible studies were extracted and included into the meta-analyses using a random effects model. Electronical literature search identified 15 studies including 1934 patients with CRC mostly detecting survivin by immunohistochemistry (IHC). Pooled hazard ratios of 11 studies that performed survival analysis revealed a positive correlation between survivin expression and poor prognosis (HR 1.93; 95% CI: 1.55–2.42; P<0.00001; I2 = 23%). Subgroup analyses with respect to the detection method, HR estimation, global quality score and the country of origin in which the study was conducted supported the stability of this observation. In addition, meta-analyses revealed a significant association between expression of survivin and the presence of lymph node metastases (OR: 0.37; 95% CI: 0.19–0.75; I2 = 61%) or blood vessel invasion (OR: 0.50; 95% CI: 0.28–0.90; I2 = 0%). Expression of survivin indicates poor prognosis and a pro-metastatic phenotype and may be useful in identifying a subgroup of patients that could benefit from a targeted therapy against survivin in CRC.
Highlights
As reported by the International Agency for Research on Cancer, colorectal cancer (CRC) causes about 608.000 deaths worldwide per year, making it the fourth leading cause of cancerrelated deaths after lung, stomach and liver cancer [1]
Literature Search A literature search via PubMed and EMBASE databases was conducted on November 21st, 2012 to find articles that assessed the role of survivin in CRC using the following keywords and text words: (1) colon or colonic or colorectal or rectal, and (2) cancer or carcinoma or tumor or neoplasm, and (3) survivin or BIRC5
By careful reading the abstracts we identified 53 studies that focused on the expression of survivin in colon cancer specimen and were included in our full-text review process
Summary
As reported by the International Agency for Research on Cancer, colorectal cancer (CRC) causes about 608.000 deaths worldwide per year, making it the fourth leading cause of cancerrelated deaths after lung, stomach and liver cancer [1]. The therapy for patients with UICC (Union for International Cancer Control) stage I and II is the primary resection according to oncological principles. A basic principle in identifying suitable molecular targets is to profile tumors for potential molecular biomarkers that are associated with prognosis and tumor progression [6]. Molecular targets such as vascular endothelial growth factor (VEGF), human epidermal growth factor receptors (EGFR) and others have been identified in CRC and are either already used in anticancer therapies or are under evaluation in clinical trials [5]
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