title: Survivin expression in breast cancer predicts clinical outcome and is associated with HER2, VEGF, urokinase plasminogen activator and PAI-1.
abstract: BACKGROUND
  Survivin, a novel inhibitor of apoptosis, is one of the most cancer-specific proteins identified to date. In this study we (a) evaluated the association between survivin and HER2, vascular endothelial growth factor (VEGF) and uPA/PAI-1 expression and (b) defined its effect on clinical outcome in a large breast cancer patient cohort.
  
  
  METHODS
  Survivin expression was measured by ELISA in primary breast cancer tissue extracts from 420 patients with long-term clinical follow-up.
  
  
  RESULTS
  Survivin was detected in 378 (90%) of the 420 primary breast cancer cases. Increased survivin levels were significantly associated with high nuclear grade (P < 0.0001), negative hormone receptor status (P = 0.0028), HER2 overexpression (P = 0.0094), VEGF expression (P < 0.0001), high uPA (P = 0.0002) and PAI-1 levels (P = 0.0002). Using the 25th percentile (1.4 ng/mg) as a cut-off point, patients expressing elevated survivin had a significantly worse disease-free survival (DFS: P = 0.0007, RR 1.97) and overall survival (OS: P = 0.0009, RR 2.11) compared with patients expressing lower levels of survivin. In multivariate analysis, this prognostic value of survivin was independent of both traditional and novel clinicopathologic factors for both DFS (P = 0.0076, RR 1.72) and OS (P = 0.0155, RR 1.76).
  
  
  CONCLUSIONS
  The independent prognostic relevance of survivin, when combined with previous data from model systems implicating survivin in the inhibition of apoptosis, suggests that survivin may be a suitable target for future therapeutic strategies.
authors.affiliation: School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland. Brid.Ryan@ucd.ie
authors.forename: B M
authors.initials: BM
authors.lastname: Ryan
authors.forename: G E
authors.initials: GE
authors.lastname: Konecny
authors.forename: S
authors.initials: S
authors.lastname: Kahlert
authors.forename: H-J
authors.initials: HJ
authors.lastname: Wang
authors.forename: M
authors.initials: M
authors.lastname: Untch
authors.forename: G
authors.initials: G
authors.lastname: Meng
authors.forename: M D
authors.initials: MD
authors.lastname: Pegram
authors.forename: K C
authors.initials: KC
authors.lastname: Podratz
authors.forename: J
authors.initials: J
authors.lastname: Crown
authors.forename: D J
authors.initials: DJ
authors.lastname: Slamon
authors.forename: M J
authors.initials: MJ
authors.lastname: Duffy
mesh_terms: D001943:Breast Neoplasms / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins; D008869:Microtubule-Associated Proteins / Q000378:metabolism*; D009363:Neoplasm Proteins / Q000378:metabolism*; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D000077022:Survivin; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000378:metabolism*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*
chemical_list: D051034:Inhibitor of Apoptosis Proteins; D008869:Microtubule-Associated Proteins; D009363:Neoplasm Proteins; D017395:Plasminogen Activator Inhibitor 1; D018719:Erb-b2 Receptor Tyrosine Kinases; D000077022:Survivin; D014568:Urokinase-Type Plasminogen Activator; D042461:Vascular Endothelial Growth Factor A; C107489:BIRC5 protein, human