Survivin Expression in Cervix Carcinoma Correlates with Residual Disease after Neoadjuvant Radio-Chemotherapy
Gian Franco Zannoni, Valerio Gaetano Vellone, Esther Diana Rossi, Guido Fadda, Gaia Chiarello, Giovanni Scambia, Guido Rindi. Catholic University, Rome, Italy
Background: Radio-chemotherapy followed by surgery represents a therapeutic option for advanced cervical cancer. The identification of potential markers of response is crucial for planning the treatment. Survivin is a family member of the inhibitor of apoptosis (IAP) which is the primary mode of cell death induction by several classes of anticancer agents and ionizing radiation. The relationship between survivin immunohistochemical expression on pre-treatment biopsy and pathological assessed response to radio-chemotherapy on surgical specimens is investigated.
Design: The study included 52 primary uterine cervix cancer patients treated with radio-chemotherapy followed by surgey. Immunohistochemistry was performed on the pre-treatment biopsy using the polyclonal rabbit anti-survivin antibody. Results (Hscore) were evaluated according to Pallares 2005 .
Histological response to therapy was classified on the hysterectomy specimen as follows : pR0: Pathological Complete Response, pR1:Pathological Partial Response, pR2: Pathological No Response.
After the examination of all surgical specimens, all patients were restaged according to TNM and FIGO: FIGO 0 were considered as “No Residual Disease” (NRD); FIGO stages I-II were considered as “Local Residual Disease” (LRD); FIGO stages III-IV were considered as “Metastatic Disease” (MD).
Results: The histological examination of the completely sampled cervix disclosed 25 pR0 cases (48,07%), 17 pR1 cases (32,69%) and 10 pR2 cases (19,23%). pR2 patients showed a significant higher Hscore compared to both pR0 (135,2±76,38 Vs 200±58,3; p=0,021) and pR1 (124,11±63,84 Vs 200±58,3; p=0,011). No statistically significant differences were observed between pR0 and pR1. After the examination of all the surgical specimens, 24 patients (46,16%) were staged as NRD, 23 (44,23%) as LRD (44,23%) and 5 (9,61%) as MD. MD patients showed a significant higher Hscore compared to both NRD (134,58±77,96 Vs 228±48,68; p=0,01) and LRD (130,11±60,23 Vs 228±48,68; p=0,004). No statistically significant differences between NRD and LRD were observed.
Conclusions: Patients with higher survivin expression show a worse local and systemic response than patients with lower expression. These findings confirm the role of survivin in cancer cell resistance to therapy.
 Pallares J et al. Int J Gynecol Pathol. 2005 Jul;24(3):247-53.
 Zannoni GF et al. Int J Gynecol Pathol. 2008 Apr;27(2):274-81.
Category: Gynecologic & Obstetrics
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 132, Wednesday Morning