Survivin expression and its relationship with apoptosis and prognosis in nasal and paranasal sinus carcinomas

The inverse correlation found in this study between survivin expression and the level of spontaneous apoptosis in nasal and paranasal sinus carcinoma (NPSC) suggests that survivin may play an important role in the tumorigenesis of NPSC. Survivin expression may provide a novel predictive indicator for disease-free survival after surgical resection and postoperative radiochemotherapy in NPSC.

NPSC is the third commonest neoplasm in otolaryngology. Little is known about the distribution of inhibitors of apoptosis in NPSC and how they correlate with the prognoses of patients. The objectives of this study were to assess the protein expression of a new inhibitor of apoptosis, survivin, and its correlation with spontaneous apoptosis, tumor clinicopathological parameters and prognosis in NPSC.

A total of 48 patients (23 females, 25 males; age range 20-71 years) with NPSC treated by means of radical operations between 1991 and 2000 were studied retrospectively. Spontaneous apoptotic cells were visualized by means of terminal deoxynucleotide transferase-mediated dUTP nick-end labeling in combination with hematoxylin-eosin and propidium iodide staining. Immunohistochemistry using the streptavidin-peroxidase method was used to assess the expression of survivin.

Survivin expression was positive in 23/48 samples (47.92%) but no staining was present in normal tissues adjacent to the tumors. The expression of survivin correlated negatively with the apoptotic index (r = - 0.393; p = 0.006). Patients with positive expression of survivin had a lower apoptotic index than those with negative expression (p < 0.05). The expression of survivin in advanced-stage tumors (T3 + T4) was higher than that in early ones (T1 + T2) (p < 0.05). Patients with negative expression of survivin had a much better prognosis than those with positive expression (p = 0.0346). Multivariate analyses revealed that expression of survivin and histological type were independent prognostic factors for overall survival.