Survivin expression predicts early recurrence in early-stage breast cancer

Background: The apoptosis inhibitor survivin is one of the most specific proteins in breast cancer patients. The role of this protein in predicting prognosis is still controversial. Patients and Methods: Survivin mRNA was measured using quantitative TaqMan reverse transcription-PCR in 76 samples, including 48 early-stage breast cancer tissues and adjacent normal tissues, from patients with operable tumors, and was tested for correlation with established clinicopathological factors, or disease-free survival (DFS). Results: Comparing the survivin expression in 78 breast cancer patients with the clinicopathological factors (age, menopausal status, nodal category, tumor histology, tumor size, histological grade, ER and PgR status, and type of operation), T factor (T1-T4) was significantly associated with a high survivin mRNA ratio (p=0.0104). The proportion of tumors with a high survivin mRNA ratio was greater in node-positive than in node-negative tumors (p=0.0001), and in grade III tumors compared to grade I or grade II tumors (p=0.0001). Patients with low survivin expression showed significantly better disease-free survival than patients with high survivin expression in stage I and 11 breast cancer (p < 0.0001, log-rank). Survivin expression alone is a powerful prognostic factor for disease-free survival of breast cancer patients without nodal involvement (HR: 0.024, 95%CI: 0.001-0.446, p=0.0123) using Cox multivariate regression analysis. Conclusion: Survivin is an indicator of the recurrence of early-stage breast cancer. Survivin might be used as a new marker to stratify early-stage breast cancer patients for more optimal treatment modalities, or it could be a promising target for therapy.