Clinicopathological and Prognostic Significance of SRY Box Transcription Factor 2 (SOX2) Overexpression in Central Nervous System Tumor A Meta-Analysis

Background: Central nervous system (CNS) tumors have been recognized as a type of tumor with high progressivity and a five-year survival rate of just 36%. SRY-related high mobility group box-2 (SOX2) is a gene encoding the Sox2 protein which is found to be overexpressed in various CNS tumors and contribute to its progressiveness. This gene contributes to CNS tumors through several signaling pathways, including Shh, Wnt, FGFR, and TGF-? signaling pathways. This meta-analysis aims to evaluate the clinicopathological and prognostic significance of SOX2 overexpression in CNS tumor. Patients and methods: The literature searches on Cochrane Library, PubMed, and ScienceDirect were conducted systematically up to December 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method to find relevant references. The effect of SOX2 overexpression on clinicopathological characteristics and prognostic value were analyzed using Review Manager 5.4 (Cochrane Collaboration, Oxford, UK). Results: Ten suitable studies with a total of 466 patients with CNS tumors including gliomas (glioblastoma, astrocytoma, oligoastrocytoma, and oligodendrogliomas) and meningiomas, were included. Our analysis shows a significant association between the overexpression of SOX2 with the grade of CNS tumor (OR 7.05; 95%CI: 2.83 to 17.53; I2 = 53%; p< 0.0001) both in gliomas and meningiomas, with gender (OR 2.08; 95%CI: 1.30 to 3.34; I2 = 13%; p = 0.002) especially in non-Asian population, and higher in primary tumor than recurrent tumor (OR 4.31; 95%CI: 1.41 to 13.14; I2 = 13%; p = 0.01). On the prognostic value, SOX2 overexpression insignificantly associates with poor overall survival (HR 1.73; 95%CI: 0.49 to 6.18; I2 = 83%; p = 0.40) Conclusion: SOX2 overexpression suggests a role as a biomarker in predicting the poorer grade of CNS tumors