Clinicopathologic significance of survivin expression in colorectal adenocarcinoma

Background and aim: Survivin, an antiapoptotic protein, is involved in both the control of the cell division and the inhibition of apoptosis. The regulation of apoptotic cell death may have a profound effect on the carcinogenesis and progression of colorectal cancer. This study was designed to evaluate the survivin expression in colorectal tissues and to investigate whether the survivin expression is associated with the clinicopathologic characteristics and the patient survival. Methods: Immunohistochemical analysis of survivin was performed using the tissue microarrays of 622 colorectal tissue samples from 529 colorectal adenocarcinomas, 40 normal mucosa, 34 adenomatous polyps, and 59 metastatic lymph nodes. Results: Normal colorectal mucosa were completely negative for survivin (0/40, 0%), but survivin was expressed in adenomatous polyps (8/34, 23.5%), adenocarcinomas (327/529, 61.8%), and metastatic lymph nodes (27/59, 45.8%). In the analyses between the survivin expression and clinicopathologic parameters, the survivin expression was correlated with tumor location in colon (P= 0.026), lymph node metastasis (P= 0.003) and American Joint Committee on Cancer (AJCC) stage (P= 0.040). The patient survival was significantly associated with age, histologic grade, AJCC stage, and lymphovascular invasion. On stage wise analyses of patient survival, the survivin expression was significantly correlated with overall survival (P < 0.001) and disease free survival (P < 0.001), especially in stage II colorectal adenocarcinomas. Conclusions: The results suggest that the survivin expression is a relatively frequent early event of colorectal carcinogenesis and may play an important role in the adenoma-carcinoma transition sequence. Survivin expression provides important prognostic information and an apoptosis-based therapeutic target in colorectal adenocarcinomas.