방광암에서 survivin의 예후적 가치 : 체계적 문헌고찰과 메타 분석

학위논문 (석사)-- 서울대학교 대학원 : 의학과, 2015. 2. 구자현.Prognostic role of survivin in bladder cancer: systematic review and meta-analysis Objective: The objective of the present study was to conduct a system atic review and m eta-analysis of published literature investigating the survivin expression and its effects on bladder cancer prognosis. Materials & Methods: W e carefully searched online Pubm ed, Cochrane Library and SCOPUS database from August 1997 to M ay 2013. Results: A total of 14 articles m et the eligibility criteria for this system atic review. The eligible studies included a total of 2,165 patients with a m edian num ber of 155 patients per study (range: 17-726). Of the 14 studies, nine evaluated im m unohistochem istry in form alin-fixed paraffin- em bedded tissue blocks. In non-m uscle invasive bladder tum or, the pooled hazard ratio (HR) was statistically significant for recurrence-free survival (pooled HR, 1.8195% confidence interval [CI], 1.30-2.52), progression- free survival (pooled HR, 2.1295% CI, 1.60-2.82), cancer-specific survival (pooled HR, 2.0195% CI, 1.32-3.06), and overall survival (pooled HR, 1.5395% CI, 1.02-2.29). These estim ates of the overall HRs by survivin status were robust across advanced stages. W hen only adjusted survival data were included, statistically significant differences were identified for all survival subgroup analyses. There was no between-study heterogeneity in the effect of survivin status on the m ajority of m eta-analyses. There was no clear evidence of publication bias in this m eta-analysis. Conclusion: Our m eta-analysis has yielded significant association between survivin expression and bladder cancer prognosis. However, it is rather necessary that better designed studies need to provide a better conclusion about the relationship between survivin expression and the outcom e of patients with bladder cancer.Abstract .............................................................................. i Contents ........................................................................... iii List of tables...................................................................... iv List of figures...................................................................... v List of appendices ..............................................................vi . Introduction ...................................................................1 . M aterials and M ethods.................................................. 3 1. Search strategy and selection criteria .............................3 2. Data extraction and quality assessm ents ........................ 4 3. Statistical analysis ...................................................... 5 . Results.......................................................................... 8 . Discussion.................................................................. 12 . Conclusions................................................................17 References...................................................................... 18 Abstract in Korean............................................................ 41Maste