title: Expression of survivin in squamous cell carcinoma and transitional cell carcinoma of the urinary bladder: a comparative immunohistochemical study.
abstract: OBJECTIVE
  To compare the expression of survivin and its association with clinicopathological criteria in major types of urinary bladder carcinoma, specifically, transitional cell carcinoma with and without squamous differentiation and squamous cell carcinoma.
  
  
  METHODS
  Immunohistochemical staining for survivin and Ki67 was performed on paraffin-embedded sections of 104 carcinomas: 52 transitional cell carcinoma, 20 transitional cell carcinoma with squamous differentiation, and 32 squamous cell carcinoma. Expression of survivin in >10% of tumor cells was described as altered survivin status. Ki67 staining in >20% of tumor cells was described as a high proliferation index.
  
  
  RESULTS
  Altered survivin expression was detected in 60/104 specimens (58%) and was significantly more frequent in transitional cell carcinoma (78%) than in squamous cell carcinoma (38%) or transitional cell carcinoma with squamous differentiation (40%) (p<0.0001). In transitional cell carcinoma but not in squamous cell carcinoma, altered survivin status was associated with higher tumor grade, higher proliferation index, and recurrence. In the whole specimens, altered survivin expression was significantly associated with advanced stage (p<0.001), recurrence (p=0.005), distant metastasis (p<0.001), and death (p=0.001). In the multivariate analysis, altered survivin was an independent poor prognostic factor for recurrence.
  
  
  CONCLUSIONS
  Unlike in transitional cell carcinoma, alteration of survivin expression in squamous cell carcinoma occurs less frequently and is not associated with features of tumor aggression or patient outcome. These findings raise a question: are urinary bladder carcinoma patients with squamous cell carcinoma type suitable candidates for survivin vaccine? This is an important question to be answered before approving the vaccine in management.
authors.affiliation: Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Rania
authors.initials: R
authors.lastname: Makboul
authors.affiliation: Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Abeer E L-Refaiy M
authors.initials: AE
authors.lastname: Refaiy
authors.affiliation: Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Fatma Ahmed Mahmoud
authors.initials: FA
authors.lastname: Badary
authors.affiliation: Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Islam F
authors.initials: IF
authors.lastname: Abdelkawi
authors.affiliation: Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany.
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
authors.affiliation: Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Rabab Ahmed Ahmed
authors.initials: RA
authors.lastname: Mohammed
mesh_terms: D014408:Biomarkers, Tumor; D002294:Carcinoma, Squamous Cell / Q000235:genetics*; D002295:Carcinoma, Transitional Cell / Q000235:genetics*; D005260:Female; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins / Q000235:genetics / Q000378:metabolism*; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D000077022:Survivin; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000235:genetics*
chemical_list: C107489:BIRC5 protein, human; D014408:Biomarkers, Tumor; D051034:Inhibitor of Apoptosis Proteins; D019394:Ki-67 Antigen; D000077022:Survivin
keywords: Squamous cell carcinoma; Transitional cell carcinoma; Urinary bladder; Vaccines