title: Prognostic value of survivin in patients with non-small cell lung carcinoma: a systematic review with meta-analysis.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  Relevant 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.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Department of Thoracic Surgery, Jiangsu Cancer Hospital, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Lou Qian
authors.initials: LQ
authors.lastname: Zhang
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Feng
authors.initials: F
authors.lastname: Jiang
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.forename: Fu Yin
authors.initials: FY
authors.lastname: Liu
authors.forename: Rong
authors.initials: R
authors.lastname: Yin
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood*; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins / Q000097:blood*; D008175:Lung Neoplasms / Q000097:blood*; D011379:Prognosis; D000077022:Survivin
chemical_list: C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; D000077022:Survivin