Prognostic role of survivin in bladder cancer : a systematic review and meta-analysis

Abstract

Prognostic role of survivin in bladder cancer: systematic review and meta-analysis

Objective: The objective of the present study was to conduct a system atic review and m eta-analysis of published literature investigating the survivin expression and its effects on bladder cancer prognosis. Materials & Methods: W e carefully searched online Pubm ed, Cochrane Library and SCOPUS database from August 1997 to M ay 2013. Results: A total of 14 articles m et the eligibility criteria for this system atic review. The eligible studies included a total of 2,165 patients with a m edian num ber of 155 patients per study (range: 17-726). Of the 14 studies, nine evaluated im m unohistochem istry in form alin-fixed paraffin- em bedded tissue blocks. In non-m uscle invasive bladder tum or, the pooled hazard ratio (HR) was statistically significant for recurrence-free survival (pooled HR, 1.81

95% confidence interval [CI], 1.30-2.52), progression- free survival (pooled HR, 2.12

95% CI, 1.60-2.82), cancer-specific survival (pooled HR, 2.01

95% CI, 1.32-3.06), and overall survival (pooled HR, 1.53

95% CI, 1.02-2.29). These estim ates of the overall HRs by survivin status were robust across advanced stages. W hen only adjusted survival data were included, statistically significant differences were identified for all survival subgroup analyses. There was no between-study heterogeneity in the effect of survivin status on the m ajority of m eta-analyses. There was no clear evidence of publication bias in this m eta-analysis. Conclusion: Our m eta-analysis has yielded significant association between survivin expression and bladder cancer prognosis. However, it is rather necessary that better designed studies need to provide a better conclusion about the relationship between survivin expression and the outcom e of patients with bladder cancer.