Nuclear Survivin in pN2 Non-small Cell Lung Cancer : Prognostic and Clinical Implications

¹ Dept of Thoracic Surgery; and Dept of Pulmonology, Faculty of Medicine, Assiut University, Egypt
² Dept of Thoracic Surgery
³ Diagnostic Pathology, Graduate School of Medicine, Chiba University, Japan
⁴ Dept of Pulmonology, Faculty of Medicine, Assiut University, Egypt

^* To whom correspondence should be addressed. E-mail: kyasufuku{at}faculty.chiba-u.jp.

	Abstract

Patients with N2 non-small cell lung cancer (N2-NSCLC) represent heterogeneous groups. Survivin is a member of the inhibitor of apoptosis (IAP) family. If N2-NSCLC patients could be stratified, based on survivin expression and/or its relation to cell cycle proteins, into homogeneous subgroups, certain therapies could be selected for those patients.

Survivin expression in 78 surgically-resected primary pN2-NSCLC tumours, was evaluated using immunohistochemistry. Relationships of survivin expression to overall survival, clinical features, and 6 cell cycle-related proteins' expressions (pRb, cyclin D1, p16^INK4A, p53, p21^Waf1, ki-67) were analyzed.

Nuclear survivin and the number of mediastinal lymph node (LN) stations were independent prognostic factors. Patients' group with combined negative survivin/single mediastinal LN station were the most favorable prognostic group, and was related to the clinical nodal factor. Indeed, patients with negative survivin/low Ki-67 labelling indices had the best survival, especially in non-squamous histopathology.

We conclude that, nuclear survivin is strongly related to LN metastasis and proliferative potentials in pN2-NSCLC patients. Preoperative N2-NSCLC patients with combined negative nuclear survivin and single mediastinal LN station, or low proliferative indices, particularly in clinical N0-1 disease and non-squamous histopathology, respectively, are expected to have a favorable postoperative prognosis and may be candidates for primary resection.