Immunohistochemical detection of the anti-apoptosis protein, survivin, predicts survival after curative resection of stage II colorectal carcinomas

Background: This study examined the role of Survivin protein, a novel inhib itor of apoptosis, in determining prognosis after curative resection of sta ge II colorectal carcinomas. Methods: Expression of Survivin, P53, and BCL-2 was evaluated immunohistoch emically in stage II colorectal carcinomas from 49 patients who were follow ed for up to 9 years after operation. The Cox proportional hazards regressi on model was used to examine the predictive value of several covariates, Results: The patients comprised 33 men and 16 women with a median age of 71 years. There were 32 colonic and 17 rectal cancers comprising 40 T3 and ni ne T4 primary tumors. Survivin was expressed in 30 (61.2%), P53 in 30 (61.2 %), and BCL-2 in 21 (42.9%) tumors. Expression of Survivin was independent of P53 or BCL-2 expression and histopathological characteristics of the tum or. The 5-year survival rate of patients with Survivin-positive tumors was significantly lower than that of patients with Survivin-negative tumors (52 .5% vs. 94.1%, respectively; P = .01). On multivariate analysis, expression of Survivin (Hazard Ratio [HR] = 9; P = .03), and rectal origin of cancer (HR = 3; P = .05) were the only factors which independently predicted an in creased risk of death from recurrent cancer. Conclusion: Survivin expression within the tumor can identify patients with stage II colorectal carcinoma who are at increased risk of death from recu rrent disease and might particularly benefit from adjuvant therapy.