title: Survivin expression can predict the effect of chemoradiotherapy for advanced lower rectal cancer.
abstract: BACKGROUND
  Chemoradiotherapy (CRT) has been used to improve local control and survival in patients with advanced rectal carcinoma. However, a significant proportion of patients show poor response to adjuvant CRT. We thus investigated the usefulness of survivin expression as a predictive marker of the CRT response and its characteristics.
  
  
  METHODS
  Forty-three patients with lower rectal cancer who underwent CRT were investigated. All patients received preoperative CRT consisting of TS-1 concurrent with 40 Gy of pelvic irradiation followed by curative resection. The relationship between clinical response, or pathological response, and the expression of survivin of pre-CRT biopsy specimens was evaluated by immunohistochemistry and compared with post-CRT expression.
  
  
  RESULTS
  Positive expression of survivin was observed in 26 of 43 patients (60%) in pre-CRT specimens. Survivin was positively expressed in 77% of stable disease cases, and 43% of partial response (p < 0.05). Regarding the correlation between pathological response and survivin expression, positive expression of survivin was recognized in 75% (18 of 24) of Grade 0 + 1 cases, 50% (7 of 14) of Grade 2 cases, and 20% (1 of 5) of Grade 3 cases. A reverse correlation was recognized between pathological responses and survivin expression (p < 0.05). There were differences in the tumor differentiation between the survivin-positive group and the negative group (p < 0.05). The expression concordance rate was 66% between pre- and post-CRT tissues. In post-CRT tissues, nuclear survivin expression disappeared completely and cytoplasmic expression increased, especially in responder cases.
  
  
  CONCLUSIONS
  Survivin expression in biopsy could be an important predictive factor of preoperative CRT response.
authors.affiliation: Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan, mikami@clin.med.tokushima-u.ac.jp.
authors.forename: Chie
authors.initials: C
authors.lastname: Takasu
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Kurita
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwata
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Sato
authors.forename: Masanori
authors.initials: M
authors.lastname: Nishioka
authors.forename: Shinya
authors.initials: S
authors.lastname: Morimoto
authors.forename: Kozo
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Miyatani
authors.forename: Hideya
authors.initials: H
authors.lastname: Kashihara
authors.forename: Tohru
authors.initials: T
authors.lastname: Utsunomiya
authors.forename: Hisanori
authors.initials: H
authors.lastname: Uehara
mesh_terms: D000368:Aged; D001706:Biopsy; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins / Q000096:biosynthesis* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy; D057234:Preoperative Period; D011379:Prognosis; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000077022:Survivin; D016896:Treatment Outcome
chemical_list: C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; D000077022:Survivin