title: Clinicopathological significance of survivin expression in patients with cervical cancer: A systematic meta-analysis.
abstract: BACKGROUND
  Survivin has been shown to play an important role in cancer pathogenesis. However, its role in cervical cancer development is still controversial. This study was performed to evaluate the clinical significance of survivin expression in cervical cancer.
  
  
  METHODS
  Search of some online electronic databases was conducted to identify available studies. The pooled odds ratios (ORs) with its 95% confidence intervals (CIs) were calculated and analyzed.
  
  
  RESULTS
  Finally, 18 eligible studies with 791 cervical cancer patients, 1,013 cervical intraepithelial neoplasia (CIN) lesions, 199 normal cervical tissues, and 95 samples with chronic cervicitis were identified in this analysis. The pooled OR of survivin expression was found to be significantly higher in the samples from cervical cancer than in those from CIN lesions, normal cervical tissues, and chronic cervicitis. When cervical cancer was compared to CIN lesions, the subgroup analysis by ethnicity showed that survivin expression was associated with a risk of cervical cancer in Asians (P < 0.001), but not in Caucasians (P = 0.659). In addition, survivin was significantly more overexpressed in high-grade cervical cancer than in low-grade cervical cancer. Its expression was also more elevated in advanced-stage patients than in early-stage patients, in lymph node metastasis than in lymph node without metastasis, and in squamous cell carcinoma (SCC) than in adenocarcinoma (AC).
  
  
  CONCLUSIONS
  The expression of survivin may play a key role in the carcinogenesis, progression, and metastasis of cervical cancer. However, survivin expression may be involved in the progression of CIN lesions only in the Asian population. Survivin expression is associated with an increased risk of SCC. Additional studies with larger sample sizes are needed in the future to confirm our findings.
authors.affiliation: a Department of Obstetrics and Gynecology , The Fifth Clinical Medical College of Yangzhou University, the Second People's Hospital of Obstetrics and Gynecology of Changshu City , Changshu , China.
authors.forename: Yibing
authors.initials: Y
authors.lastname: Fan
authors.affiliation: b Department of Gynecology , GongLi Hospital Affiliated of the Second Military Medical University , Shanghai , China.
authors.forename: Juan
authors.initials: J
authors.lastname: Chen
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D005260:Female; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins / Q000378:metabolism*; D009363:Neoplasm Proteins / Q000378:metabolism; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D000077022:Survivin; D002583:Uterine Cervical Neoplasms / Q000208:ethnology* / Q000378:metabolism* / Q000473:pathology; D044465:White People / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000208:ethnology* / Q000378:metabolism* / Q000473:pathology
chemical_list: C107489:BIRC5 protein, human; D014408:Biomarkers, Tumor; D051034:Inhibitor of Apoptosis Proteins; D009363:Neoplasm Proteins; D000077022:Survivin
keywords: CIN lesions; cervical cancer; clinicopathological features; expression; survivin protein