Livin, Survivin and Caspase 3 as early recurrence markers in non-muscle-invasive bladder cancer

To explore the potential correlation and prognostic value of Livin, Survivin and Caspase 3 expression in non-muscle-invasive bladder cancer (NMIBC). We prospectively examined the simultaneous expression of Livin, Survivin and Caspase 3 with immunohistochemistry in the paraffin blocks of 138 patients who underwent transurethral resection, and ten cases of normal bladder specimens were studied as the control group. During a 48-month follow-up, clinical pathologic factors including gender, age, pathology stage, histology grade, adjuvant therapy and recurrence time were recorded. The curves for recurrence-free survival (RFS) were estimated by the Kaplan-Meier method, and the relationship between these proteins' expression and clinical pathologic factors was analyzed with the Cox regression model. Livin and Survivin showed a high expression (H-exp) level of 65.22 and 71.01 % in NMIBC, respectively, whereas Caspase 3 expression level was 50.72 %, and H-exp level of Livin and Survivin were 72.7 and 80.0 % in pT1 stage, respectively, which were proved to be higher than that in pTa/Tis ratio (P < 0.05). The relation between the H-exp and low-expression (L-exp) groups of Livin and Survivin and RFS were found statistically significant (P < 0.05). Conversely, there was better RFS in H-exp Caspase 3 group than in L-exp group (P < 0.05). A risk score was developed on the basis of all three biomarkers to estimate the prognosis of NMIBC patients, and those expressing high Survivin and Livin and low Caspase 3 had a significant shorter RFS time (P < 0.05). Livin, Survivin and Caspase 3 may be valuable as promising indicators of early recurrence in NMIBC.