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

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.

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.

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.

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.