Role of Survivin expression in predicting biochemical recurrence after radical prostatectomy: a multi-institutional study

OBJECTIVE: To assess the association of Survivin expression with clinicopathological features and biochemical recurrence (BCR) after radical prostatectomy (RP) in a large multi-institutional cohort.

METHODS: Survivin expression was evaluated by immunohistochemistry on a tissue microarray of RP cores from 3117 patients. Survivin expression was considered altered when at least 10% of the tumor cells stained positive. Association of altered Survivin expression with BCR was evaluated using Cox proportional hazards regression models.

RESULTS: Survivin expression was altered in 1330 (42.6%) patients. Altered expression was associated with higher Gleason score on RP (p=0.001), extracapsular extension (p=0.019), seminal vesicle invasion (p<0.001) and lymph node metastases (p=0.009). Median follow up was 38 months (IQR 21-66). Patients with altered Survivin had a shorter BCR free survival than those with normal expression (5-year BCR free survival estimates: 74.7% vs 79.0%, p=0.008). Altered Survivin, however did not retain its prognostic value when adjusted for the effect of established clinico-pathological factors (p=0.73). Subgroup analyses also showed no independent prognostic value of Survivin.

CONCLUSIONS: Survivin expression is commonly altered in RP patients. Altered Survivin expression is associated with clinicopathologic features of biologically and clinically aggressive PCa. Survivin expression was associated with BCR only in univariable analysis, limiting its value in daily clinical decision making. This article is protected by copyright. All rights reserved.