title: Nuclear survivin expression predicts poor outcome in cholangiocarcinoma.
abstract: OBJECTIVE
  Survivin is an anti-apoptotic protein expressed in cancer and may have prognostic value. Our study examined the prognostic role of survivin in biliary cancer.
  
  
  METHODS
  Twenty-four consecutive cases of cholangiocarcinoma were studied. Immunohistochemistry was performed using a monoclonal antibody to survivin. Survivin expression was described as absent or weak and strong.
  
  
  RESULTS
  Median age was 68 years (range 40 to 77). There were 16 females and 8 males. SEER (Surveillance, Epidemiology and End Results) staging was local in 2, regional in 15 and distant in 7. Treatments included chemotherapy (n=3), surgery (n=9), combined modality (n=10) or no therapy (n=2). Cytoplasmic and nuclear survivin expression was seen in 13 and 11 patients respectively. Strong cytoplasmic survivin expression was seen in 6 cases and strong nuclear survivin in 4. Patients with strong nuclear survivin had a median survival of 11 months, significantly lower than for patients with weak nuclear survivin expression (20 months, p=0.033). Multivariate analysis using the Cox-proportional hazards model identified 4 important prognostic predictors: nuclear survivin (P=0.022), presence of metastasis (P=0.025), age (P=0.019) and use of combined modality therapy (P=0.006).
  
  
  CONCLUSIONS
  Nuclear survivin expression in cholangiocarcinoma may identify those with a poor prognosis.
authors.affiliation: Department of Medicine, Roswell Park Cancer Institute and State University of New York at Buffalo, 14263, USA. milind.javle@roswellpark.org
authors.forename: Milind M
authors.initials: MM
authors.lastname: Javle
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Tan
authors.forename: Jihnhee
authors.initials: J
authors.lastname: Yu
authors.forename: Charles M
authors.initials: CM
authors.lastname: LeVea
authors.forename: Fengzhi
authors.initials: F
authors.lastname: Li
authors.forename: Boris W
authors.initials: BW
authors.lastname: Kuvshinoff
authors.forename: John F
authors.initials: JF
authors.lastname: Gibbs
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D014408:Biomarkers, Tumor / Q000032:analysis*; D001707:Biopsy, Needle; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016001:Confidence Intervals; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007150:Immunohistochemistry; D051034:Inhibitor of Apoptosis Proteins; D008297:Male; D008869:Microtubule-Associated Proteins / Q000235:genetics / Q000378:metabolism*; D008875:Middle Aged; D009363:Neoplasm Proteins; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D000077022:Survivin
chemical_list: C107489:BIRC5 protein, human; D014408:Biomarkers, Tumor; D051034:Inhibitor of Apoptosis Proteins; D008869:Microtubule-Associated Proteins; D009363:Neoplasm Proteins; D000077022:Survivin