Krieg Andreas, Werner Thomas A, Verde Pablo E, Stoecklein Nikolas H, Knoefel Wolfram T
Department of Surgery A, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany.
PLoS One. 2013 Jun 3;8(6):e65338. doi: 10.1371/journal.pone.0065338. Print 2013.
Survivin/BIRC5 is a potentially interesting prognostic marker and therapeutic target in colorectal cancer (CRC). However, the available data on survivin expression in CRC are heterogeneous. Thus, to clarify the prognostic relevance of survivin in patients with CRC and its association with clinicopathological parameters we performed a meta-analysis. We screened PubMed and EMBASE for those studies that investigated the prognostic value of survivin and its association with clinicopathological parameters in CRC. Data from eligible studies were extracted and included into the meta-analyses using a random effects model. Electronical literature search identified 15 studies including 1934 patients with CRC mostly detecting survivin by immunohistochemistry (IHC). Pooled hazard ratios of 11 studies that performed survival analysis revealed a positive correlation between survivin expression and poor prognosis (HR 1.93; 95% CI: 1.55-2.42; P<0.00001; I(2) = 23%). Subgroup analyses with respect to the detection method, HR estimation, global quality score and the country of origin in which the study was conducted supported the stability of this observation. In addition, meta-analyses revealed a significant association between expression of survivin and the presence of lymph node metastases (OR: 0.37; 95% CI: 0.19-0.75; I(2) = 61%) or blood vessel invasion (OR: 0.50; 95% CI: 0.28-0.90; I(2) = 0%). Expression of survivin indicates poor prognosis and a pro-metastatic phenotype and may be useful in identifying a subgroup of patients that could benefit from a targeted therapy against survivin in CRC.
生存素/BIRC5是结直肠癌（CRC）中一个潜在有趣的预后标志物和治疗靶点。然而，关于CRC中生存素表达的现有数据存在异质性。因此，为了阐明生存素在CRC患者中的预后相关性及其与临床病理参数的关联，我们进行了一项荟萃分析。我们在PubMed和EMBASE中筛选了那些研究生存素在CRC中的预后价值及其与临床病理参数关联的研究。从符合条件的研究中提取数据，并使用随机效应模型纳入荟萃分析。电子文献检索确定了15项研究，包括1934例CRC患者，大多通过免疫组织化学（IHC）检测生存素。进行生存分析的11项研究的合并风险比显示，生存素表达与预后不良呈正相关（HR 1.93；95%CI：1.55 - 2.42；P<0.00001；I(2)=23%）。关于检测方法、HR估计、整体质量评分以及研究开展所在国家的亚组分析支持了这一观察结果的稳定性。此外，荟萃分析显示生存素表达与淋巴结转移（OR：0.37；95%CI：0.19 - 0.75；I(2)=61%）或血管侵犯（OR：0.50；95%CI：0.28 - 0.90；I(2)=0%）之间存在显著关联。生存素表达表明预后不良和促转移表型，可能有助于识别CRC中可能从针对生存素的靶向治疗中获益的患者亚组。
