Survivin Expression as a Predictive Marker for Local Control in Patients With High-Risk T1 Bladder Cancer Treated With Transurethral Resection and Radiochemotherapy

Purpose The objectives of this study were to investigate the expression of survivin in tumor samples from patients with high-risk T1 bladder cancer and to correlate its expression with clinicopathologic features as well as clinical outcomes after initial transurethral resection (TURBT) followed by r...

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Published in:	International journal of radiation oncology, biology, physics Vol. 74; no. 5; pp. 1455 - 1460
Main Authors:	Weiss, Christian, M.D, von Römer, Felix, Capalbo, Gianni, Ph.D, Ott, Oliver J., M.D, Wittlinger, Michael, M.D, Krause, Steffen F., M.D, Sauer, Rolf, M.D, Rödel, Claus, M.D, Rödel, Franz, Ph.D
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-08-2009
Subjects:	Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use BLADDER Carcinoma in Situ - chemistry Carcinoma in Situ - mortality Carcinoma in Situ - pathology Carcinoma in Situ - therapy CARCINOMAS Combined Modality Therapy - methods DEATH Disease Progression Female HAZARDS Hematology, Oncology and Palliative Medicine High-risk T1 bladder cancer Humans Inhibitor of Apoptosis Proteins Male Microtubule-Associated Proteins - analysis Neoplasm Proteins - analysis Neoplasm Recurrence, Local Organ preservation PATIENTS PRESERVATION PROTEINS Radiochemotherapy Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy Dosage Survival Rate Survivin Urinary Bladder Neoplasms - chemistry Urinary Bladder Neoplasms - mortality Urinary Bladder Neoplasms - pathology Urinary Bladder Neoplasms - therapy High-risk T1 bladder cancer Organ preservation Survivin Radiochemotherapy
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Summary:	Purpose The objectives of this study were to investigate the expression of survivin in tumor samples from patients with high-risk T1 bladder cancer and to correlate its expression with clinicopathologic features as well as clinical outcomes after initial transurethral resection (TURBT) followed by radiotherapy (RT) or radiochemotherapy (RCT). Methods and Materials Survivin protein expression was evaluated by immunohistochemistry on tumor specimen ( n = 48) from the initial TURBT, and was correlated with clinical and histopathologic characteristics as well as with 5-year rates of local failure, tumor progression, and death from urothelial cancer after primary bladder sparring treatment with RT/RCT. Results Survivin was not expressed in normal bladder urothelium but was overexpressed in 67% of T1 tumors. No association between survivin expression and clinicopathologic factors (age, gender, grading, multifocality, associated carcinoma in situ ) could be shown. With a median follow-up of 27 months (range, 3–140 months), elevated survivin expression was significantly associated with an increased probability of local failure after TURBT and RCT/RT ( p = 0.003). There was also a clear trend toward a higher risk of tumor progression ( p = 0.07) and lower disease-specific survival ( p = 0.10). Conclusions High survivin expression is a marker of tumor aggressiveness and may help to identify a subgroup of patients with T1 bladder cancer at a high risk for recurrence when treated with primary organ-sparing approaches such as TURBT and RCT.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0360-3016 1879-355X
DOI:	10.1016/j.ijrobp.2008.10.063