Prognostic Relevance of Survivin in Pancreatic Endocrine Tumors

Better prognostic markers are needed for pancreatic endocrine tumors. Survivin is an apoptosis inhibitor that is suggested to have a negative prognostic impact in several tumor types. Contradictory data exist, especially regarding the significance of a nuclear versus cytoplasmic location of survivin. The prognostic relevance of nuclear and cytoplasmic survivin expression in pancreatic endocrine tumors-controlled for the tumor Ki-67 index, World Health Organization classification, and TNM stage-was investigated. A total of 111 patients treated at a tertiary referral center were retrospectively evaluated. Clinical data were gathered from medical records. Immunohistochemistry for survivin and Ki-67 was performed on paraffin-embedded tissue. Univariate and multivariate Cox analyses were performed. Patients with tumors that had < 5% survivin-positive nuclei had a mean survival of 225 months [95% confidence interval (CI) 168-281]. The corresponding figure for patients with 5 to 50% survivin-positive tumor cell nuclei was 101 months [95% CI 61-140; hazard ratio (HR) 2.4; < 0.01) and with > 50% survivin-positive nuclei 47 months (95% CI 24-71; HR 4.9; < 0.001). Nuclear survivin expression in > 50% of the tumor cells was an independent marker of a poor prognosis (HR 5.7; < 0.01). Cytoplasmic survivin was not a significant prognostic factor in the multivariate analysis (HR 0.94; = 0.90). High expression of nuclear survivin is a significant marker of a poor prognosis in patients with a pancreatic endocrine tumor.