Prognostic Significance of Survivin Expression in Osteosarcoma Patients: A Meta-Analysis.

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.

Material And 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.