Survivin, Possible Marker and Prognostic Factor in Oral Squamous Cell Carcinomas

Survivin is a member of the inhibitors of apoptosis (IAP) family that have been known to inhibit activated caspases in apoptosis. In contrast to most IAP family members, survivin mRNA is expressed during fetal development, is not found in normal adult tissues and is overexpressed again in the cancer. Though survivin expression has been documented in most human cancers, little is known about its expression in OSCC and its potential value as a predictor of cancer survival. The purpose of this study was to investigate survivin expression in OSCC and to evaluate its value as a prognostic marker. We evaluated survivin expressions in cancer lines and OSCC samples and investigated the relationships between survivin expressions and clinico-pathological parameters including stage, differentiation, proliferation, lymph node metastasis, blood vessel density, and gelatinolytic activity. With immunohistochemistry, we analyzed survivin expression in 38 OSCCs. Patients' clinico-pathological parameters and their survival rate were analyzed to reveal their correlations with Survivin expressions. We cultured oral cancer cell lines and evaluated the correlation between gelatinolytic activities and survivin expressions of them. Survivin protein was observed both in nuclei and cytoplasm of tumor specimens while little or not observed in normal gingival mucosal tissues. Additionally, survivin expressions were correlated with lymph node metastasis, tumor proliferation and survival rate. Survivin expression was observed in 100% of 38 samples of OSCC and its expression levels are statistically associated with the proliferative activity of the tumors, lymph node metastasis and the survival of the patients. Based on these results, survivin is commonly expressed in OSCC and may thus provide valuable prognostic information related with lymph node metastasis, proliferation and survival rate as well as a potential therapeutic target in OSCC.

Prognostic Analysis of Patients of Oral Squamous Cell Carcinoma in Seoul National University Hospital Using Computer-Aided Individual Prognosis (CIP)

TNM system has been generally used for the clinical classification and the estimation of the prognosis of malignant tumors but it has been criticized for its accuracy in the field of oral and maxillofacial malignant tumors. This is because the prognoses of tumors are affected by so many factors, which have been not fully understood yet. For oral squamous cell carcinoma, "Treatment-dependent prognosis Index(TPI)" was developed from the retrospective DOSAK(German-Austrian-Swiss Association for Head and Neck Tumors) study from 1952 to 1985 for the purpose of more accurate and more objective estimations of prognoses. Considering the additional factors, DOSAK developed TPI into "Computer-Aided Individual Prognosis (CIP)" from the prospective study in 1992. We yielded and compared the estimated survival rates and the real survival rates in 145 patients who can be traced their survival out of 241 oral squamous cell carcinoma patents in Seoul National University Hospital during a decade from 1986 to 1995 using Computer-Aided Individual Prognosis (CIP). The patients were divided into group of overall, groups of nonevidence of disease and evidence of disease, groups divided by stage, groups divided by T classifications and by N classifications. The results are as follows. 1. Overall five-year survival rates are 53.6% in real survival rate and 25.4% in estimated survival rate. Generally the real survival rates are higher than the estimated survival rates in the standard of 5 year survival rates. 2. The differences of survival rates are up to maximum 43.3% in stage 2 and minimum 17.1% in N2. 3. Among 15 groups, 11 groups have statistical meaningful correlations (p<0.01) except stage2, stage 3, N1 and N3 The prognoses of Korean oral squamous patients were able to be estimated indirectly by CIP. For the more accurate estimation of the prognoses of Korean oral squamous patients, it is necessary to develop our own CIP program through the systemic epidemic studies.

Application of Treatment-dependent Prognosis Index (TPI) for determination of the prognosis in the cases of Oral Squamous Cell Carcinoma

Applied TNM-system for determination and prognostic classification of the cancer patients of Oral and Maxillofacial region does, however, only partly justice, if at all, to the nature of the tumor disease. And the TNM-system implies among other defects a crude simplification of the complex pattern of the tumor disease. But in clinical practice, the prognosis must be determined on the bases of a specific combination of clinical factors under consideration of various therapeutical conditions. For more reliable and objective prognosis determination for the cancer patients of Oral and Maxillofacial region, `Retrospective DOSAK(German-Austrian-Swiss Association for Head and Neck Tumors) study' introduced Treatment-dependent Prognosis Index TPI in 1982. Treatment-dependent Prognosis Index TPI gives the clinician an opportunity to determine the prognosis before starting therapy at the time of the first admission of the patient, during the therapy and immediately after complete of the therapy. The fundamental purpose of the TPI can be summarized as follows. 1) In clinical-therapeutical cancer research the TPI provides a sound basis for the planning and verification of therapy studies. 2) In clinical practice the TPI allows a reliable and objective determination of the prognosis for the individual patient and thus provides the clinician valuable assistance in planning the treatment. The authors estimated the survival curves of the 179 cases of squamous cell carcinoma from 1985.1.1 to 1992.8.31 in the Department of Oral and Maxillofacial Surgery, Seoul National University Hospital according to Treatment-dependent Prognosis Index TPI of Retrospective DOSAK study and compared with the survival curves observed in long term study on prognosis of patients.