title: Lack of prognostic significance of survivin in pediatric medulloblastoma.
abstract: Medulloblastoma (MDB) is the most common malignant cerebellar tumor in children. Because of the significant rate of mortality and treatment-related morbidity, the identification of prognostic factors could lead to a more accurate selection of patients who can benefit from a less aggressive therapy and improve risk stratification. Survivin is an inhibitor of apoptosis protein (IAP), the expression of which has been associated with worse prognosis in MDB. However, both of its subcellular localizations may contribute to tumor progression, and ultimately, survivin subcellular localization prognostic value depends on tumor type biological features. The goal of this study was to analyze these survivin features in the pediatric MDB tumor samples and its impact on clinical outcome. Survivin expression and subcellular localization were accessed by immunohistochemistry in a series of 41 tumor samples. Kaplan-Meier survival curves were compared using the log-rank test. Survivin expression ranged from completely absent to fully present in a notably higher pattern of nuclear localization than cytoplasmic (19 of 41 versus 4 of 41, respectively). However, survivin expression and subcellular localization were not associated with five-year overall survival or metastasis status at diagnosis, which was the only statistically significant prognostic factor in our series (p = 0.008). Taken together, our results suggest that survivin expression should be further studied in large, multicenter series to determine its accurate impact on prognosis and pathobiology of pediatric MDB.
authors.affiliation: Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Pesquisa em Hemato-Oncologia Molecular, Coordenação Geral Técnico-Científica, Instituto Nacional de Câncer, Praça da Cruz Vermelha, 23, 6o andar, Ala B, Centro, 20230-130 Rio de Janeiro, RJ, Brazil.
authors.forename: Roberta Soares
authors.initials: RS
authors.lastname: Faccion
authors.forename: Regina Moreira
authors.initials: RM
authors.lastname: Ferreira
authors.forename: Marília Fornaciari
authors.initials: MF
authors.lastname: Grabois
authors.forename: Theresinha Carvalho
authors.initials: TC
authors.lastname: Fonseca
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: de Oliveira
authors.forename: Raquel Ciuvalschi
authors.initials: RC
authors.lastname: Maia
mesh_terms: D000293:Adolescent; D002467:Cell Nucleus / Q000378:metabolism; D002528:Cerebellar Neoplasms / Q000235:genetics / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003593:Cytoplasm / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007223:Infant; D051034:Inhibitor of Apoptosis Proteins / Q000096:biosynthesis / Q000235:genetics / Q000378:metabolism*; D053208:Kaplan-Meier Estimate; D008297:Male; D008527:Medulloblastoma / Q000235:genetics / Q000378:metabolism*; D009363:Neoplasm Proteins / Q000096:biosynthesis / Q000235:genetics / Q000378:metabolism; D011379:Prognosis; D015996:Survival Rate; D000077022:Survivin
chemical_list: C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; D009363:Neoplasm Proteins; D000077022:Survivin