Abstract
PurposeThe 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.MethodsRelevant 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.ResultsWe 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.ConclusionThis 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.
Highlights
Lung cancer is the leading cause of death from cancer around the world, accounted for an estimated 157,300 deaths in the United States in 2010 [1]
Literature Selection and Characteristics A total of 317 potentially relevant citations were retrieved after initial databases search
Two hundred and seventy-three citations were excluded from analysis after the first screening based on abstracts or titles, leaving 44 available for further full text review
Summary
Lung cancer is the leading cause of death from cancer around the world, accounted for an estimated 157,300 deaths in the United States in 2010 [1]. Several independent prognostic factors for survival in NSCLC patients have been identified: performance status, disease stage, age, sex, and amount of weight lost [4]. The most important prognostic factor for survival is tumor stage, primarily because early stage disease is amenable to completely surgical resection, hopefully before the tumor cells have acquired the ability to metastasize. Even in the early stage of the disease, about 30% of patients suffer from relapse and die within 5 years of surgery [5]. These prognostic parameters do reflect biological features of both tumor and patient, they do not allow adequate prediction of outcome for the individual patient. The three important pathways in lung cancer: cell cycle regulation, apoptosis, and angiogenesis are widely investigated
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