Survivin expression in breast carcinoma: Correlation with apoptosis and prognosis

Background: Survivin is a novel inhibitor of apoptosis commonly detected in tissues during fetal development and in cancer, but not Usually in normal tissues. It has been suggested that the expression of this protein may be of prognostic significance in gastric, colorectal, and bladder carcinomas. We assessed survivin expression in breast carcinomas correlating results with expression of other antiapoptotic (bcl-2, bcl-x) and proapoptotic (bax) markers, with prognostic parameters, and with prognosis. Design: Paraffin-embedded sections of 37 breast carcinomas were immunostained for survivin, bcl-2, bcl-x, and bax. Expression was evaluated in normal breast tissue and carei-oma, nuclei and cytoplasm, as intensity (0 to 3+), and percentage of positive cells. Results: Survivin expression was noted in 30 (81%) of breast carcinomas, and in normal breast tissue, in nuclei, and cytoplasm. There was a significant correlation (P=0.022) between survivin and bcl-x expression; survivin and bcl-x tended to correlate with overall survival (P=0.072 and 0.075, respectively), but not with disease-free survival (P=0.19 and 0.18, respectively). There was no correlation of survivin with bcl-2 or bax expression, or with other prognostic parameters (age, tumor size, histologic type, histologic grade, nodal status, and tumor stage) (P > 0.05). Conclusion: The majority (81%) of breast carcinomas show survivin expression which correlates with bcl-x, another antiapoptotic marker, and both markers tend to correlate with prognosis.