title: Meta-analysis: prognostic value of survivin in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  The expression of survivin is a promising prognostic indicator for some carcinomas. However, evidence for the prognostic value of survivin with respect to survival in hepatocellular carcinoma remains controversial.
  
  
  OBJECTIVE
  To conduct a systematic review of studies evaluating survivin expression in hepatocellular carcinoma as a prognostic indicator.
  
  
  METHODS
  The relevant literature was searched using PubMed, EMBASE, and Chinese biomedicine databases, and two meta-analyses were performed. One studied the association between survivin expression and the overall survival of patients with hepatocellular carcinoma, whereas the other studied the association between survivin expression and disease-free survival. Studies were pooled, and summary hazard ratios (HRs) were calculated. Subgroup analyses were also conducted.
  
  
  RESULTS
  Fourteen eligible studies with a total of 890 patients were included in this study. Two meta-analyses were performed according to the different outcomes by which prognosis was valued. The combined HR of the overall survival studies was 2.33 (95% CI: 1.65-3.31). The combined HR of disease-free survival studies was 2.13 (95% CI: 1.65-2.75). These data appeared to be significant when stratified by detection method, the language of publication, and HR estimate. The heterogeneities were highly significant (I(2)>50%) when subgroup analyses of overall survival rate were conducted, whereas little heterogeneity was found when subgroup analyses of disease-free survival rate were carried out. The positive expression of survivin in the cytoplasm was significantly correlated with poor prognosis in HCC (HR>1).
  
  
  CONCLUSIONS
  This study showed that survivin expression was correlated with poor prognosis in patients with hepatocellular carcinoma, regardless whether they were assessed by overall survival or disease-free survival.
authors.affiliation: Department of Hepatobiliary Surgery, The Chinese PLA General Hospital, Beijing, China ; Department of General Surgery 1, The Affiliated Hospital of Chengde Medical College, Chengde City, China.
authors.forename: Jin Long
authors.initials: JL
authors.lastname: Liu
authors.affiliation: Department of General Surgery 1, The Affiliated Hospital of Chengde Medical College, Chengde City, China.
authors.forename: Xue Jun
authors.initials: XJ
authors.lastname: Zhang
authors.affiliation: Department of General Surgery 1, The Affiliated Hospital of Chengde Medical College, Chengde City, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, The Chinese PLA General Hospital, Beijing, China.
authors.forename: An Hong
authors.initials: AH
authors.lastname: Zhang
authors.affiliation: Department of Vascular Surgery, The People's Liberation Army 252 Hospital, Baoding City, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary Surgery, The Chinese PLA General Hospital, Beijing, China.
authors.forename: Jia Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D014408:Biomarkers, Tumor; D006528:Carcinoma, Hepatocellular / Q000378:metabolism* / Q000401:mortality*; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins / Q000378:metabolism*; D008113:Liver Neoplasms / Q000378:metabolism* / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D017594:Publication Bias; D000077022:Survivin
chemical_list: C107489:BIRC5 protein, human; D014408:Biomarkers, Tumor; D051034:Inhibitor of Apoptosis Proteins; D000077022:Survivin