Anti-apoptosis Gene, Survivin Expression and Prognosis of Neuroblstoma

ABSTRACT

PURPOSE: The prognostic significance of survivin expression (SE), which has been reported to be an inhibitor of apoptosis protein, was examined in order to identify a more accurate prognostic grouping of neuroblastomas. METHODS: Thirty-seven tumor specimens were obtained between 1992 and 2002. The SE level was examined by immunohistochemical techniques using paraffin-embedded tissues, and was scored as being positive when more than 5% of the cells reacted with the anti-survivin antibody. The outcome of the stratified potential prognostic groups was evaluated according to age, location, stage, Shimada class and SE. The correlation between the SE level and the prognostic factors were analyzed using a univariate assessment. The predictive value of SE in the prognosis was determined using a multivariate assessment. RESULTS: The median follow up period was 23 months. The 5-year overall survival rate was significantly reduced with an advanced stage, adrenal primary, unfavorable Shimada class and positive SE (P=.01, .01, .02 and .00). A positive SE was correlated with old age, advanced stage and an unfavorable Shimada class (P=.03, .00 and .03). The relative risk of the SE positive group was 5.20 (P=.01). Survivin was expressed in 73% of recurred cases, but in only 31% of non-recurred cases (P=.04). CONCLUSIONS: Survivin expression is a valid independent prognostic factor for a neuroblastoma, which correlates withthe disease progression and a poor prognosis.