Bladder cancer refers to a malignant tumor occurring in the bladder mucosa, which is primarily identified in the posterior wall, lateral wall, top, and triangular area of the bladder [1]. Moreover, it has been reported as the fourth most common malignant tumor for males worldwide [2], with males’ prevalence exceeding females’. Bladder cancer is characterized by high incidence, recurrence, and mortality. Relevant statistics have suggested that nearly 573,000 new cases of bladder cancer were reported, of which about 213,000 died in 2020; 70% of patients suffering from nonmuscle invasive bladder cancer (NMIBC) had recurrent tumors, and the 5-year survival rate has reached about 90% [3]. Early diagnosis and treatment of bladder cancer are capable of effectively prolonging the survival time of patients. The gold standard to diagnose bladder cancer is histopathology, which does not apply to the early diagnosis for its invasion [4]. Thus, a practical method should be urgently developed for early diagnosis.

Biomarkers refer to specific biomolecules (e.g., DNA, proteins, enzymes, lipids, and glycans), indicating the nature of the process of pathogenic factors or toxicants from exposure to effect [5]. The ideal biomarker of bladder cancer should be subjected to safe, fast, and convenient detection, with higher sensitivity and specificity and low cost. Survivin is the best inhibitor of apoptosis, which attaches to the family of apoptosis-inhibiting proteins. Survivin can't expressed in normal tissues and cells. However, survivin is highly expressed in most malignant tumors, suggesting that survivin can serve as a biomarker diagnosing the earlier bladder cancer [6].

Numerous studies have focused on the diagnostic significance about survivin as a biomarker for bladder cancer. But there is much controversy around the results of some existing studies. The sensitivity and specificity of survivin in rapid noninvasive detection of bladder cancer using survivin were 0.95 (95%CI: 0.83, 0.99) and 0.93 (95%CI: 0.78, 0.99), respectively [7]. However, another study found that the sensitivity and specificity of survivin in the diagnosis of bladder cancer reached 0.69 (95%CI: 0.51, 0.83) and 1.00 (95%CI: 0.89, 1.00), respectively [8]. Meta-analysis has been confirmed as a systematic evaluation of the results of multiple studies based on quantitative methods, which is capable of comprehensively collecting all relevant studies and critically evaluating and analyzing them separately. Subsequently, the data were statistically processed with quantitative synthetic methods to draw comprehensive conclusions, such that the problems of small sample size of individual studies and single source of sample size can be reasonably solved [9].

In accordance with the above conflicting data, a systematic review and meta-analysis was conducted to assess the performance of survivin in diagnosis of bladder cancer.