Survivin protein expression and hypoxia in advanced cervical carcinoma of patients treated by radiotherapy

BackgroundSurvivin is strongly overexpressed in the vast majority of cancers. Initial investigations suggest a role for Survivin in radiation resistance. In this study, we investigate the effect of Survivin expression on clinical outcome and its relationship to tumor oxygenation parameters, expression of Hif-1α and anemia in patients with advanced cervical cancers treated with radiotherapy.Material and methodsBiopsies of 44 patients with cervical cancers (Stage IIB: n = 9; Stage IIIB: n = 31; Stage IVA: n = 4) treated with radiotherapy were assessed by immunochemistry for expression of Survivin. Relation of Survivin to pretreatment tumor oxygenation parameters (HF5, pO2), hemoglobin (hb) level, Hif-1α expression and clinical parameters were investigated.ResultsSurvivin expression was detected in all tumors of the 44 patients. Seven showed a strong expression and 37 have moderate Survivin expression. Patients whose tumors showed moderate Survivin expression had a 5-year overall survival of 66%. However, only one of the seven patients with strong Survivin expression was alive 45 months after treatment. In a Cox regression analysis, Survivin expression was correlated to poor overall survival (p = 0.02, RR = 3.3). There was no relationship between Survivin expression and pO2 or HF5, but rather an inverse correlation with hemoglobin level (p = 0.04). Furthermore, for six of the seven tumors with a high Survivin expression, Hif-1α was detected.ConclusionSurvivin protein expression is linked with anemia and prognosis in advanced cervical carcinoma of patients treated by radiotherapy.