Clinical Significance of the Survivin Expression in Intrahepatic Cholangiocarcinoma with Hepatolithiasis

ABSTRACT

PURPOSE: Hepatolithiasis has been regarded as having a potential of to invoke cholangiocarcinogenesis. The aim of this study was to examine the expression of survivin in hepatolithiasis and cholangiocarcinoma, and to try to predict whether hepatolithiasis plays a role in the carcinogenesis of cholangiocarcinoma. We also investigated the expression of survivin according to subcellular sites (cytoplasmic and nuclear) in the cholangiocarcinoma specimens and to correlation this with the clinical outcome. METHODS: Thirty-four surgically resected hepatolithiasis specimens and ten stone-containing cholangiocarcinoma specimens were the focus of this study. Immunohistochemical staining was done to check the expression of survivin in the hepatolithiasis and cholangiocarcinoma specimens. We classified the survivin positive group according to the subcellular sites in the cholangiocarcinoma specimens. RESULTS: The expression rate of survivin was 5.9% in the hyperplasia specimens, 47.1% in the dysplasia specimens and 90% in the adenocarcinoma specimens (p < 0.01), respectively. The over expression of nuclear and cytoplasmic survivin was seen in 3 specimens and 6 specimens, respectively, among the survivin positive specimens (9 total specimens) of the cholangiocarcinoma specimens. The median survival time of the nuclear and cytoplasmic expression groups of patients was 1.5 months and 10 months, respectively. CONCLUSION: We conclude that the overexpression of survivin in hepatolithiasis could be associated with cholangiocarcinoma based on the sequentially increased survivin expression. We purpose that the nuclear survivin expression predicts aggressive clinical behavior of cholangiocarcninoma.