Beyond pancreatic carcinoma: The close relationship between survivin levels and prognosis in systemic malignancies

Abstract

I read with great interest the recent article by Liu and Wang in a recent issue of your esteemed journal. The article is highly thought provoking. Interestingly, the past few years have seen a number of studies that have established a close relationship between survivin expression and tumor prognosis in systemic malignancies besides pancreatic carcinomas. For instance, a poor prognosis is seen in patients with bladder carcinomas which exhibit survivin over expression. A higher recurrence rate is seen following radio-chemotherapy in bladder carcinomas which exhibit increased survivin expression. Similarly, up regulation of survivin expression is seen in non-small cell lung cancers. In fact, Yamashita et al have shown that when used in combination with p53AIP1, survivin is a powerful prognostic indicator in non-small cell lung carcinomas. Similarly in breast carcinomas, increased survivin expression is more commonly seen in estrogen receptor negative carcinomas and is associated with a poor overall prognosis.

Key Words: Survivin; Cancer; Malignancy

TO THE EDITOR

I read with great interest the recent article by Liu and Wang[1] in a recent issue of your esteemed journal. The article is highly thought provoking. Interestingly, the past few years have seen a number of studies that have established a close relationship between survivin expression and tumor prognosis in systemic malignancies besides pancreatic carcinomas.

For instance, a poor prognosis is seen in patients with bladder carcinomas which exhibit survivin over expression. A higher recurrence rate is seen following radio-chemotherapy in bladder carcinomas which exhibit increased survivin expression[2]. Similarly, up regulation of survivin expression is seen in non-small cell lung cancers[3]. In fact, Yamashita et al[4] have shown that when used in combination with p53AIP1, survivin is a powerful prognostic indicator in non-small cell lung carcinomas. Similarly in breast carcinomas, increased survivin expression is more commonly seen in estrogen receptor negative carcinomas and is associated with a poor overall prognosis[5].

Similarly, there is a close co-relation between prognosis in colo-rectal carcinomas and survivin expression by cancerous colo-rectal cells[6]. A similar relationship is seen in esophageal squamous cell carcinomas where high survivin mRNA levels are associated with a poor prognosis and low survival rates[7]. Higher survivin levels are also seen in high risk human papillomavirus infections and are an early stage marker of cervical malignancies[8]. Interestingly, high grade bladder carcinomas are associated with elevated urine survivin levels[9]. Not surprisingly the positive predictable value of urine survivin in diagnosing bladder carcinomas is close to 92%.

The above examples illustrate the clinical usefulness of survivin as a significant prognostic indicator in malignancies ranging from esophageal carcinomas to cervical carcinomas. Further large scale studies are needed to further investigate if survivin levels may predict tumor prognosis in other systemic malignancies besides those mentioned above.