Expression of survivin in renal cell carcinomas: association with pathologic features and clinical outcome.

OBJECTIVES: To investigate the expression of survivin in renal cell carcinoma and try to define its association with certain pathologic features and the clinical outcome.

METHODS: The tissue samples from 85 consecutive renal cell carcinoma specimens were obtained from patients who had undergone radical or partial nephrectomy. The mean follow-up was 45 months (range 3 to 60). Immunohistochemical staining of the paraffin sections of the pathologic sample was performed using monoclonal antibody for survivin with the standard avidin-biotin-peroxidase technique. The mean expression rate of survivin was assessed by inspection of at least five microscopic fields at 400x magnification. Expression of survivin was considered positive when more than 10% of the cancer cells in the microscopic fields demonstrated immunostaining. The degree of expression of survivin was compared with the clinicopathologic features.

RESULTS: Survivin was expressed in 67 (79%) of 85 samples. Immunostaining for survivin was demonstrated in the cytoplasm of tumor cells and in vascular endothelial cells. A significant increase in survivin expression was associated with increased T stage (P = 0.044), increased tumor grade (P = 0.0013), and low recurrence-free survival (P = 0.046). Multivariate Cox regression analysis revealed that survivin expression is an independent prognostic parameter (P = 0.021) in renal cell carcinoma.

CONCLUSIONS: The results of this study suggest that survivin-mediated inhibition of apoptosis is associated with progression and recurrence of renal cell carcinoma. Thus, survivin is a useful independent prognostic marker for this condition.