Expression of survivin and livin predicts early recurrence in non-muscle invasive bladder cancer.

ABSTRACT

BACKGROUND: Survivin and livin are novel members of the inhibitor of apoptosis gene family (IAP) that controls mitotic progression and induces tumor cell invasion. This study aims to evaluate the association of both expression with clinical outcomes and risk of recurrence in patients with non-muscle invasive bladder cancer (NIMBC). PATIENTS AND METHODS: We investigated the expression of survivin and livin in 72 NMIBC samples using immunohistochemical staining (Envision Method). Survivin and livin were considered high-expressed when more than 10% of the cells expressed. The archival bladder tissue specimens from 11 normal controls were examined and studied. All patients with a follow-up of at most 5 years following initial transurethral resection (TUR) were included in the study. The association of both expression with established clinicopathologic factors and recurrence free survival (RFS) was analyzed using log-rank test and Cox regression analysis. RESUTS Neither survivin nor livin was expressed in normal bladder urothelium. Survivin and livin were high-expressed in 84.7 and 75.0% of NIMBC. And in cases of recurrence, the high-expression (H-exp.) rates were 98.3 and 91.7% (P < 0.01), respectively. The recurrence of NIMBC was significantly associated with high expression of survivin and livin (P < 0.01, P < 0.01), and G-3 tumors had a significantly greater proportion of high survivin expression than G-1 or/and G-2 tumors (P = 0.01); however, no association was found between expression of both and age, gender, pathology stage, or adjuvant therapy. High expression of survivin (RR9.818, 95% CI 1.109-86.911, P = 0.040) and livin (RR 4.199; 95% CI 1.018-17.321; P = 0.047) was significantly powerful prognostic factors in Cox regression analysis for RFS. CONCLUSIONS: Expression of survivin and livin may influence the prognosis of NIMBC. This finding opens new perspectives for Survivin and livin prediction of early recurrence in NIMBC.