Prognostic significance of Survivin and CD44v6 in laryngeal cancer surgical margins

Objective To evaluate the prognostic value of positive Survivin and CD44v6 expression in surgical margin after curative surgery for laryngeal cancer. Methods Immunohistochemistry was performed to detect the expression of Survivin and CD44v6 using polyclonal antibody on 112 pair of formalin-fixed, paraffin-embedded laryngeal cancer and negative surgical margin tissue samples, and results were compared with data from the prospective registry of laryngeal cancer by univariate and multivariate logistic regression model focusing specifically on recurrence. The survival was assessed by the Kaplan-Meier method and proportional hazards model. Results Survivin and CD44v6 expression in surgical margins were documented in 39.3% (n = 44) and 31.3% (n = 35) patients and were associated with a higher incidence of tumor progression and poorer disease-free survival (P < 0.01). Multivariate logistic regression analysis demonstrated that Survivin (P = 0.000) and CD44v6 (P = 0.001) expression in surgical margin, T-stage (P = 0.006) and histological grade (P = 0.001) were independent predictive factors for recurrence. The proportional hazards model identified Survivin (P = 0.005) and CD44v6 (P = 0.004) expression in surgical margin, T-stage (P = 0.006) and histological grade (P = 0.001), as independently related to disease-free survival. Using subgroup analysis, we found that the Survivin+/CD44v6+ subgroup has the poorest prognosis, whereas the Survivin-/CD44v6- subgroup has the best prognosis (P = 0.000). Conclusions Immunohistochemical assessment of both Survivin and CD44v6 status in negative surgical margin may be a valuable approach for predicting recurrence and survival after curative surgery for laryngeal cancer.