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
ARTICLE HIGHLIGHTS
Research background

SOX2 is a significant regulator of pluripotent cellular transcription and it helps in the reprogramming of somatic cells to the pluripotent properties. The involvement of SOX2 in cancer biology has been recently demonstrated.

Research motivation

Metastasis comprises the most important aspect of cancer-related mortality. Linking SOX2 expression to metastasis and subsequently to patient’s survival may open novel horizons for the implementation of future therapeutic strategies that target SOX2 biological pathways.

Research objectives

To investigate the association between SOX2 overexpression and the development of a metastatic phenotype as well as the survival patterns of patients with increased SOX2 ex-pression.

Research methods

A meta-analysis was conducted, including studies that recruited patients with different types of cancer and reporting SOX2 expression as either “low” or “high”, and evaluating patient survival using the relevant analytical methods [overall survival (OS) and/or disease-free survival (DFS)]. A comprehensive search of articles published between 2010 and 2018 was performed in distinct scientific databases.

Research results

A total of 20 studies involving 2643 patients (60.88% males) were included. SOX2 overexpression was significantly associated with distant metastasis (odds ratio = 1.79, 95%CI: 1.20-3.25, P < 0.008), while it was associated with lymph node metastasis only in subgroup analyses of cancers of the colon, breast, and lung. Both OS and DFS were shorter in patients expressing high SOX2, as compared to those with low SOX2 expression (hazard ratio = 1.65, 95%CI: 1.34-2.04, P < 0.001 and hazard ratio = 1.54, 95%CI: 1.14-2.08, P = 0.005, respectively).

Research conclusions

The present study adds a comprehensive insight into the significant role of SOX2 in distant metastasis of different types of cancers and its correlation to poor prognosis rather than the outcomes obtained by individual studies. In line with the increased research interest in SOX2, we showed that it can be used as a prognostic marker in cancer patients, while, on the other hand, new therapeutic strategies are urgently needed to target the biological pathways implicated in SOX2 overexpression for more effective cancer treatment.

Research perspectives

Targeting SOX2 expression in cancer regimens is warranted. Future research studies should focus on developing novel drugs as well as the identification of the cut-off values of poor prognosis.