Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jun 24, 2019; 10(6): 234-246
Published online Jun 24, 2019. doi: 10.5306/wjco.v10.i6.234
Metastatic potential and prognostic significance of SOX2: A meta-analysis
Arslaan Javaeed, Sanniya Khan Ghauri
Arslaan Javaeed, Department of Pathology, Poonch Medical College, Azad Kashmir, Rawalakot 1235, Pakistan
Sanniya Khan Ghauri, Department of Emergency Medicine, Shifa International Hospital, Islamabad, 44000, Pakistan
Author contributions: Javaeed A performed the literature search, study design and conception and data extraction, and provided final approval of the manuscript; Ghauri SK performed the data extraction, analysis and interpretation of the data, and drafting of the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Arslaan Javaeed, MBBS, MPhil, MHPE, Assistant Professor, Department of Pathology, Poonch Medical College, Azad Kashmir, Rawalakot 1235, Pakistan. arslaanjavaeed@yahoo.com
Telephone: +92-300-4717057
Received: January 21, 2019
Revised: March 31, 2019
Accepted: April 8, 2019
Published online: June 24, 2019
Processing time: 155 Days and 15.6 Hours
Abstract
BACKGROUND

SOX2 is a regulator of pluripotent cellular transcription, yet it has been recently integrated in cancer biology. The present study provides an analytic insight into the correlation of SOX2 overexpression with cancer metastasis and patient survival.

AIM

To investigate the association of SOX2 overexpression with metastasis and its implication in the prognosis of cancer patients.

METHODS

A meta-analysis was conducted including studies that compared the association of low or high SOX2 expression with lymph node metastasis (LNM) and/or distant metastasis (DM). The following data were additionally extracted: survival, including the overall survival (OS) and disease-free survival (DFS), and prevalence of high and low SOX2 expression. Odds ratios (commonly known as ORs) and their respective 95% confidence intervals (CIs) were used to investigate the association between SOX2 expression and LNM and DM, while hazard ratios (commonly known as HRs) and 95%CIs were applied to evaluate the prognostic markers.

RESULTS

In a total of 2643 patients (60.88% males), the pooled prevalence of SOX2 overexpression was 46.22% (95%CI: 39.07%-53.38%) in different types of cancer. SOX2 overexpression significantly correlated with DM (OR = 1.79, 95%CI: 1.20-3.25, P < 0.008) compared to low SOX2 expression. In subgroups analyses, a high SOX2 expression was associated with LNM in cancers of the lung, breast, and colon and associated with DM in hepatic, head and neck, and colon cancers. SOX2 overexpression was also associated with a shorter OS (HR = 1.65, 95%CI: 1.34-2.04, P < 0.001) and DFS (HR = 1.54, 95%CI: 1.14-2.08, P = 0.005).

CONCLUSION

A remarkable role of SOX2 overexpression was observed in cancer biology and metastasis. However, many questions in the regulatory pathways need to be addressed to reveal as many functional aspects as possible to tailor new targeted therapeutic strategies.

Keywords: Tumor progression; SOX2; Cancer; Cancer stem cell markers; Lymphatic metastasis

Core tip: SOX2 overexpression is associated with both lymph node and distant metastasis predominantly in cancers of the colon and head and neck. Targeting the biological pathways of SOX2 seems to provide a promising rationale for developing relevant therapeutic interventions.