Survivin蛋白与非小细胞肺癌危险因素的系统评价

目的系统评价存活蛋白（Survivin）表达水平与非小细胞肺癌（non-small cell lung cancer,NSCLC）危险因素的关系。方法计算机检索Cochrane Library(2011年第1期)，PubMed、CNKI等数据库，并辅以手工检索，按照纳入与排除标准选择病例对照试验。评价质量及提取资料后，采用RevMan 4.2.10软件对数据库进行系统评价。结果共纳入31个研究，其中2749例NSCLC患者，778例正常对照。Meta分析结果显示：Survivin在NSCLC组及正常对照组［比值比（odds ratio，OR）=11.11，95%可信区间（confidenceinterval，CI）=5.92~20.83］ 的表达差异具有统计学意义（P<0.05）。临床病理结果显示：Survivin在T分期T3~T4期与T1~T2期（OR=2.20，95%CI:1.65~2.93）、临床分期Ⅲ~Ⅳ期与Ⅰ~Ⅱ期（OR=2.79，95%CI:1.23~6.35）、淋巴结转移组与非淋巴结转移组（OR=2.14，95%CI:1.36~3.35）、低分化组与中高分化组（OR=1.98，95%CI:1.27~3.08）间的表达差异均具有统计学意义（P<0.05）。Survivin在NSCLC男性组与女性组（OR=1.10，95%CI:0.87~1.40）、年龄<60岁组与≥60岁组（OR=1.05，95%CI:0.66~1.68）、吸烟组与非吸烟组（OR=1.18，95%CI:0.81~1.73）、病理类型鳞癌组与腺癌组（OR=1.24，95%CI:0.90~1.73）间的表达差异无统计学意义。进一步生存分析显示，Survivin阳性表达的患者5年生存率为26.69%，而阴性表达者为62.20%(OR=0.16,95%CI:0.04~0.66,P<0.05)。Spearman等级相关分析显示，Survivin与P53、Bcl-2蛋白阳性率在NSCLC中表达具有相关性（r=0.400,P<0.005;r=0.486,P<0.005）。结论Survivin在NSCLC中高表达，增加了其恶性行为的发生危险、降低了NSCLC患者5年生存率，同时Survivin与p53、Bcl-2在NSCLC表达也有一定的相关性。

Survivin Protein and Risk Factors in Non-small Cell Lung Cancer : A Systematic Review

Objective To investigate survivin protein and risk factors in non-small cell lung cancer(NSCLC)through a systematic review.Methods The published studies were searched from the Cochrane Library(Issue 1,2011),Pubmed and CNKI databases,and other relevant journals were also handsearched to identify all the relevant case-control trials.Then the quality of the included trials was assessed and meta-analysis was performed by RevMan 4.2.10software.Results A total of 31studies were recruited.As for the positive rate of survivin expression,significant differences were discovered between NSCLC and normal lung tissues(OR=11.11,95%CI:5.92～20.83,P<0.05).No significant difference was shown among gender(OR=1.10,95%CI:0.87～1.40 P>0.05),age(OR=1.05,95%CI:0.66～ 1.68,P>0.05),smoking history(OR=1.18,95%CI:0.81～1.73,P>0.05),and histologic subtype(OR =1.24,95%CI:0.90～1.73,P>0.05),respectively.There were significant differences between T3～4 and T1～2(OR=2.20,95%CI:1.65～2.93,P<0.05),clinic stagesⅢ～Ⅳand clinic stagesⅠ～Ⅱ(OR =2.79,95%CI:1.23～6.35,P<0.05),lymph node metastasis and non-lymph node metastasis(OR= 2.14,95%CI:1.36～3.35,P<0.05),cell differentiation G3and cell differentiation G1～G2(OR=1.98,95%CI=1.27～3.08,P<0.05).Moreover,the overall survival time was significantly shorter in patients with survivin expression(26.69%)than that in patients with absent survivin expression(62.20%)(OR= 0.16,95%CI=0.04～0.66,P<0.05).Survivin expression was positively correlated with p53(r=0.400,P<0.005)and Bcl-2(r=0.486,P<0.005).Conclusion Survivin expression increased malignant behaviors of NSCLC,and meanwhile substantial correlation is confirmed between survivin and both p53and Bcl-2.