title: Prognostic Significance of Survivin Expression in Osteosarcoma Patients: A Meta-Analysis.
abstract: BACKGROUND
  Osteosarcoma is the most common primary bone malignancy and has poor prognosis. Survivin has been identified as an independent prognostic factor for a majority of cancers. In the present study, we evaluated the effect of survivin expression on the clinical outcome of osteosarcoma patients.
  
  
  METHODS
  Online electronic databases were searched for related articles published between 2000 and 2015. Odds ratio (OR) and risk ratio (RR) with their 95% confidence intervals (CI) were employed to calculate the significance.
  
  
  RESULTS
  Overall, a total of 20 relevant studies were selected, including 1030 patients. No significant heterogeneity was observed among included studies (P>0.01, I2<50%). Survivin was expressed in 68.6% of all cases. Our results show that survivin expression increased the 5-year overall survival (RR=0.48, 95% CI=0.32-0.71, P=0.0002) and rate of postoperative recurrence (RR=1.80, 95% CI=1.09-2.97, P=0.02). It was associated with the grade of osteosarcoma (Enneking clinical stage, IIb-III vs. I-IIa: OR=5.26, 95% CI=3.76-7.34, P<0.00001; Price's grade, III vs. I+II: OR=2.04, 95% CI=1.16-3.61, P=0.01), metastasis, and soft tissue invasion of osteosarcoma (OR=6.25, 95% CI=3.74-10.45, P<0.00001; OR=6.15, 95% CI=3.74-10.11, P<0.00001). No relationship was found between survivin expression and sex, age, or tumor size in patients with osteosarcoma.
  
  
  CONCLUSIONS
  Our results suggest that survivin can function as a new diagnostic biomarker for osteosarcoma and be used as a reference index to determine pathology classification of osteosarcoma, providing new targets for gene therapy of osteosarcoma.
authors.affiliation: Department of Orthopedics, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China (mainland).
authors.forename: Yugang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, China (mainland).
authors.forename: Zhaowei
authors.initials: Z
authors.lastname: Teng
authors.affiliation: Department of Pharmacy, Medical College of Hebei University of Engineering, Handan, Hebei, China (mainland).
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, Medical College of Hebei University of Engineering, Handan, Hebei, China (mainland).
authors.forename: Pengfei
authors.initials: P
authors.lastname: Gao
authors.affiliation: Department of Orthopedics, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China (mainland).
authors.forename: Junli
authors.initials: J
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis / Q000378:metabolism*; D002648:Child; D003627:Data Interpretation, Statistical; D005260:Female; D020869:Gene Expression Profiling; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D012516:Osteosarcoma / Q000175:diagnosis / Q000378:metabolism*; D011184:Postoperative Period; D011379:Prognosis; D012016:Reference Values; D012737:Sex Factors; D000077022:Survivin; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; D000077022:Survivin