title: Survivin gene levels in the peripheral blood of patients with gastric cancer independently predict survival.
abstract: BACKGROUND
  The detection of circulating tumor cells (CTC) is considered a promising tool for improving risk stratification in patients with solid tumors. We investigated on whether the expression of CTC related genes adds any prognostic power to the TNM staging system in patients with gastric carcinoma.
  
  
  METHODS
  Seventy patients with TNM stage I to IV gastric carcinoma were retrospectively enrolled. Peripheral blood samples were tested by means of quantitative real time PCR (qrtPCR) for the expression of four CTC related genes: carcinoembryonic antigen (CEA), cytokeratin-19 (CK19), vascular endothelial growth factor (VEGF) and Survivin (BIRC5).
  
  
  RESULTS
  Gene expression of Survivin, CK19, CEA and VEGF was higher than in normal controls in 98.6%, 97.1%, 42.9% and 38.6% of cases, respectively, suggesting a potential diagnostic value of both Survivin and CK19. At multivariable survival analysis, TNM staging and Survivin mRNA levels were retained as independent prognostic factors, demonstrating that Survivin expression in the peripheral blood adds prognostic information to the TNM system. In contrast with previously published data, the transcript abundance of CEA, CK19 and VEGF was not associated with patients' clinical outcome.
  
  
  CONCLUSIONS
  Gene expression levels of Survivin add significant prognostic value to the current TNM staging system. The validation of these findings in larger prospective and multicentric series might lead to the implementation of this biomarker in the routine clinical setting in order to optimize risk stratification and ultimately personalize the therapeutic management of these patients.
authors.affiliation: Department of Oncological & Surgical Sciences, Section of Clinica Chirurgica 2, University of Padova, via Giustiniani 2, 35128, Padua, Italy. loris.bertazza@unipd.it
authors.forename: Loris
authors.initials: L
authors.lastname: Bertazza
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.forename: Alberto
authors.initials: A
authors.lastname: Marchet
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Pilati
authors.forename: Joseph
authors.initials: J
authors.lastname: Gabrieli
authors.forename: Romano
authors.initials: R
authors.lastname: Scalerta
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics; D045744:Cell Line, Tumor; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins; D053208:Kaplan-Meier Estimate; D008297:Male; D008869:Microtubule-Associated Proteins / Q000097:blood* / Q000235:genetics*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013274:Stomach Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000235:genetics; D000077022:Survivin; D014158:Transcription, Genetic
chemical_list: C107489:BIRC5 protein, human; D014408:Biomarkers, Tumor; D051034:Inhibitor of Apoptosis Proteins; D008869:Microtubule-Associated Proteins; D000077022:Survivin