Published online Jan 31, 2009.
https://doi.org/10.4111/kju.2009.50.1.12
Clinical Implications of the Expression of Survivin and p53 in Superficial Transitional Cell Carcinoma of the Bladder
Abstract
Purpose
The prognostic value of p53 remains controversial in transitional cell carcinomas of the bladder. Survivin, an inhibitor of apoptosis, is expressed in many human cancers. Recent studies have reported increased expression of survivin in superficial transitional cell carcinomas of the bladder. We investigated the expression of survivin and p53 and the clinical implications of this expression in superficial transitional cell carcinomas of the bladder.
Materials and Methods
Immunohistochemical staining of paraffin sections using a monoclonal antibody for survivin and p53 was performed in 82 cases of superficial transitional cell carcinomas of the bladder. Correlations between the expression of survivin and p53 and clinicopathological features, such as age, multiplicity of tumor, size, recurrence, and progression, were examined.
Results
Among 82 cases, positive survivin expression (greater than 20%) was observed in 59 cases. Positive p53 expression (greater than 20%) was observed in 46 cases. There were no significant differences in age, gender, multiplicity, tumor size, tumor grade, pT stage, recurrence, or progression-free survival between p53-positive and p53-negative groups (p>0.05). Also, there were no significant differences in age, gender, multiplicity, tumor size, tumor grade, or pT stage between survivin-positive and survivin-negative groups (p>0.05). However, recurrent-free and progression-free survivals were significantly lower in the survivin-positive group than in the survivin-negative group (p<0.05).
Conclusions
The expression of survivin can be recommended as a useful marker for predicting disease recurrence and progression. Survivin may be superior to p53 as a prognostic factor in superficial transitional cell carcinoma of bladder.
Fig. 1
Immunohistochemical staining of survivin in tissue sections obtained from superficial bladder tumor. (A) Survivin was observed diffusely in bladder tumor tissue. Reduced from ×40 (brown staining). (B) Reduced from ×200 (brown staining).
Fig. 2
Immunohistochemical staining of p53 in tissue sections obtained from superficial bladder tumor. (A) p53 was observed diffusely in bladder tumor tissue. Reduced from ×40 (brown staining). (B) Reduced from ×200 (brown staining).
Fig. 3
Kaplan-Meier cumulative recurrence-free and progression-free curves of patients with superficial bladder tumor according to the survivin immunoreactivity. There were significant differences in recurrence-free (p=0.015) and progression-free survival (p=0.046) between the surviving-positive and survivin-negative groups.
Fig. 4
Kaplan-Meier cumulative recurrence-free and progression-free curves of patients with superficial bladder tumor according to p53 immunoreactivity. There were no significant differences in recurrence-free (p=0.081) and progression-free survival (p=0.793) between the p53-positive and p53-negative groups.
Table 1
Clinicopathological characteristics according to survivin expression
Table 2
Clinicopathological characteristics according to p53 expression
References
-
Lee ES, Lee CK, Lee C. Prognostic factors in superficial bladder tumor. Korean J Urol 1990;31:795–801.
-
-
Heney NM, Ahmed S, Flanagan MJ, Frable W, Corder MP, Hafermann MD, et al. Superficial bladder cancer: progression and recurrence. J Urol 1983;130:1083–1086.
-
-
Tamm I, Wang Y, Sausville E, Scudiero DA, Vigna N, Oltersdorf T, et al. IAP family protein survivin inhibits caspase activity and apoptosis induced by Fas (CD95), Bax, caspases, and anticancer drugs. Cancer Res 1998;58:5315–5320.
-
-
Crook NE, Clem RJ, Miller LK. An apoptosis-inhibiting baculovirus gene with a zinc finger-like motif. J Virol 1993;67:2168–2174.
-
-
Sarkis AS, Dalbagni G, Cordon-Cardo C, Melamed J, Zhang ZF, Sheinfeld J, et al. Association of p53 nuclear overexpression and tumor progression in carcinoma in situ of the bladder. J Urol 1994;152:388–392.
-
-
Lacombe L, Dalbagni G, Zhang ZF, Cordon-Cardo C, Fair WR, Herr HW, et al. Overexpression of p53 protein in a high-risk population of patients with superficial bladder cancer before and after bacillus Calmette-Guerin therapy: corrrelation to clinical outcomes. J Clin Oncol 1996;14:2646–2652.
-
-
Pfister C, Moore L, Allard P, Larue H, Lacombe L, Tetu B, et al. Predictive value of cell cycle markers p53, MDM2, p21, and Ki-67 in superficial bladder tumor recurrence. Clin Cancer Res 1999;5:4079–4084.
-