SURVIVIN EXPRESSION AS A PREDICTIVE MARKER FOR LOCAL CONTROL IN PATIENTS WITH HIGH-RISK T1 BLADDER CANCER TREATED WITH TRANSURETHRAL RESECTION AND RADIOCHEMOTHERAPY

Purpose The objectives of this study were to investigate the expression of survivin in tumor samples from patients with high-risk T1 bladder cancer and to correlate its expression with clinicopathologic features as well as clinical outcomes after initial transurethral resection (TURBT) followed by radiotherapy (RT) or radiochemotherapy (RCT). Methods and Materials Survivin protein expression was evaluated by immunohistochemistry on tumor specimen ( n = 48) from the initial TURBT, and was correlated with clinical and histopathologic characteristics as well as with 5-year rates of local failure, tumor progression, and death from urothelial cancer after primary bladder sparring treatment with RT/RCT. Results Survivin was not expressed in normal bladder urothelium but was overexpressed in 67% of T1 tumors. No association between survivin expression and clinicopathologic factors (age, gender, grading, multifocality, associated carcinoma in situ ) could be shown. With a median follow-up of 27 months (range, 3–140 months), elevated survivin expression was significantly associated with an increased probability of local failure after TURBT and RCT/RT ( p = 0.003). There was also a clear trend toward a higher risk of tumor progression ( p = 0.07) and lower disease-specific survival ( p = 0.10). Conclusions High survivin expression is a marker of tumor aggressiveness and may help to identify a subgroup of patients with T1 bladder cancer at a high risk for recurrence when treated with primary organ-sparing approaches such as TURBT and RCT.