Immunohistochemical Study of Prognostic Relevance of Nestin and Survivin Expression in Astrocytic glioma

Background: Identification of the cellular origin of astrocytic gliomas is a step for improving the treatment strategies. Tumor stem cells have been detected in different neoplasms and have a major role in tumor initiation, progression and therapy resistance. Objective: The study aimed to investigate the expression of nestin and survivin in different grades of astrocytic glioma as well as evaluation of their prognostic role in relation to other prognostic parameters. Methods: Immunohistochemical expressions of nestin and survivin were evaluated in 40 paraffin blocks of different grades of astrocytic glioma and correlated with other prognostic parameters. The obtained data were statistically analyzed. Results: The cases included 10 low grade, 12 anaplastic and 18 glioblastoma multiforme. There was a significant correlation between each of nestin and survivin with the histological grade of astrocytoma and tumor size (p < 0.001). Nestin was strongly correlated to survivin index (p < 0.001). The univariate analysis showed that high histological grade, high nestin score and high survivin index were significantly correlated with overall survival. Multivariate analysis for all investigated cases proved the independent prognostic significance of the nestin expression (p = 0.011). Conclusion: Nestin and survivin are adverse prognostic markers for astrocytic glioma that increase significantly with tumor progression and associated with poor overall survival. Therefore, nestin and survivin could be used to predict high risk group of astrocytoma with unfavorable outcome.