Expression of Survivin, a Novel Inhibitor of Apoptosis, in Superficial Transitional Cell Carcinoma of the Bladder

Abstract

PURPOSE: We investigated whether the over expression of survivin, a new antiapoptotic protein, might provide prognostic information in patients with superficial bladder cancer. MATERIALS AND METHODS: Immunohistochemical staining of paraffin sections using a monoclonal antibody for survivin was performed in 88 cases of superficial bladder cancer using the standard avidin-biotin-peroxidase technique. The relationships between the expression of survivin, clinicopathological characteristics and clinical outcome were analyzed. RESULTS: Survivin expression was found in tumor cells but not in nonneoplastic bladder tissues. High expressions (greater than 20%) of survivin were observed in 51 cases (58.0%) and low expression in 37 cases. No statistically significant association was observed between survivin expression and tumor grade (p = 0.052) or pathological stage (p = 0.131). When clinical data such as sex, age, tumor number, size or shape were examined in conjunction with survivin status no statistically significant relationship was noted. Patients with a high expression of survivin had worse disease-free survival rates than those with low survivin expression (log rank test p = 0.0004). Multivariate Cox proportional hazards model analysis identified survivin expression as an independent prognostic factor of disease-free survival (p = 0.009, relative risk = 3.17). CONCLUSIONS: Our findings suggest that high survivin expression may be considered a new unfavorable prognostic factor in superficial bladder cancer.