Survivin is not an independent prognostic factor for patients with upper tract urothelial carcinoma: A multi-institutional study

Romain Mathieu, Tobias Klatte, Vitaly Margulis, Jose A. Karam, Morgan Rouprêt, Christian Seitz, Pierre I. Karakiewicz, Harun Fajkovic, Christopher G. Wood, Alon Z. Weizer, Jay Raman, Mesut Remzi, Nathalie Rioux-Leclercq, Andrea Haitel, Karim Bensalah, Yair Lotan, Michael Rink, Luis A. Kluth, Douglas S. Scherr, Brian D. RobinsonShahrokh F. Shariat

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Abstract

Objective: Several small single-center studies have reported conflicting results on the prognostic value of survivin expression in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy. We attempted to validate the prognostic utility of survivin using a large multi-institutional cohort. Material and methods: Survivin expression was evaluated by immunohistochemistry in tumor tissue from 732 patients with unilateral, sporadic UTUC treated with radical nephroureterectomy between 1990 and 2008 at 7 centers. Survivin expression was considered altered when at least 10% of the tumor cells stained positive. Associations of altered survivin expression with recurrence-free survival (RFS) and cancer-specific survival (CSS) were evaluated using Cox proportional hazards regression models. Results: Altered survivin expression was observed in 288 (39.3%) tumors and was associated with more advanced pathological tumor stages ( P<0.001), lymph node metastases ( P<0.001), lymphovascular invasion ( P<0.001), tumor necrosis ( P = 0.027), and tumor architecture ( P<0.001). Median follow-up was 35 (16-64) months. There were 191 (25.4%) patients who experienced disease recurrence, and 165 patients (21.9%) died of the disease. In the univariable analysis, altered survivin expression was significantly associated with worse RFS and CSS (each P<0.001); however, altered survivin expression did not achieve independent predictive status on multivariable models ( P = 0.24 and P = 0.53). Similarly, survivin was not independently associated with outcomes in subgroup analyses, including patients with high-grade tumors. Conclusions: In UTUC, altered survivin expression is associated with worse clinicopathological features and worse RFS and CSS. However, it does not appear to be independently associated with cancer outcomes when considering standard prognostic factors.

Original languageEnglish (US)
Pages (from-to)495.e15-495.e22
JournalUrologic Oncology: Seminars and Original Investigations
Volume33
Issue number11
DOIs
StatePublished - Nov 1 2015

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Carcinoma
Neoplasms
Survival
Recurrence
Proportional Hazards Models
Necrosis
Lymph Nodes
Immunohistochemistry
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Oncology
  • Urology

Cite this

Mathieu, Romain ; Klatte, Tobias ; Margulis, Vitaly ; Karam, Jose A. ; Rouprêt, Morgan ; Seitz, Christian ; Karakiewicz, Pierre I. ; Fajkovic, Harun ; Wood, Christopher G. ; Weizer, Alon Z. ; Raman, Jay ; Remzi, Mesut ; Rioux-Leclercq, Nathalie ; Haitel, Andrea ; Bensalah, Karim ; Lotan, Yair ; Rink, Michael ; Kluth, Luis A. ; Scherr, Douglas S. ; Robinson, Brian D. ; Shariat, Shahrokh F. / Survivin is not an independent prognostic factor for patients with upper tract urothelial carcinoma : A multi-institutional study. In: Urologic Oncology: Seminars and Original Investigations. 2015 ; Vol. 33, No. 11. pp. 495.e15-495.e22.
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title = "Survivin is not an independent prognostic factor for patients with upper tract urothelial carcinoma: A multi-institutional study",
abstract = "Objective: Several small single-center studies have reported conflicting results on the prognostic value of survivin expression in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy. We attempted to validate the prognostic utility of survivin using a large multi-institutional cohort. Material and methods: Survivin expression was evaluated by immunohistochemistry in tumor tissue from 732 patients with unilateral, sporadic UTUC treated with radical nephroureterectomy between 1990 and 2008 at 7 centers. Survivin expression was considered altered when at least 10{\%} of the tumor cells stained positive. Associations of altered survivin expression with recurrence-free survival (RFS) and cancer-specific survival (CSS) were evaluated using Cox proportional hazards regression models. Results: Altered survivin expression was observed in 288 (39.3{\%}) tumors and was associated with more advanced pathological tumor stages ( P<0.001), lymph node metastases ( P<0.001), lymphovascular invasion ( P<0.001), tumor necrosis ( P = 0.027), and tumor architecture ( P<0.001). Median follow-up was 35 (16-64) months. There were 191 (25.4{\%}) patients who experienced disease recurrence, and 165 patients (21.9{\%}) died of the disease. In the univariable analysis, altered survivin expression was significantly associated with worse RFS and CSS (each P<0.001); however, altered survivin expression did not achieve independent predictive status on multivariable models ( P = 0.24 and P = 0.53). Similarly, survivin was not independently associated with outcomes in subgroup analyses, including patients with high-grade tumors. Conclusions: In UTUC, altered survivin expression is associated with worse clinicopathological features and worse RFS and CSS. However, it does not appear to be independently associated with cancer outcomes when considering standard prognostic factors.",
author = "Romain Mathieu and Tobias Klatte and Vitaly Margulis and Karam, {Jose A.} and Morgan Roupr{\^e}t and Christian Seitz and Karakiewicz, {Pierre I.} and Harun Fajkovic and Wood, {Christopher G.} and Weizer, {Alon Z.} and Jay Raman and Mesut Remzi and Nathalie Rioux-Leclercq and Andrea Haitel and Karim Bensalah and Yair Lotan and Michael Rink and Kluth, {Luis A.} and Scherr, {Douglas S.} and Robinson, {Brian D.} and Shariat, {Shahrokh F.}",
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Mathieu, R, Klatte, T, Margulis, V, Karam, JA, Rouprêt, M, Seitz, C, Karakiewicz, PI, Fajkovic, H, Wood, CG, Weizer, AZ, Raman, J, Remzi, M, Rioux-Leclercq, N, Haitel, A, Bensalah, K, Lotan, Y, Rink, M, Kluth, LA, Scherr, DS, Robinson, BD & Shariat, SF 2015, 'Survivin is not an independent prognostic factor for patients with upper tract urothelial carcinoma: A multi-institutional study', Urologic Oncology: Seminars and Original Investigations, vol. 33, no. 11, pp. 495.e15-495.e22. https://doi.org/10.1016/j.urolonc.2015.06.016

Survivin is not an independent prognostic factor for patients with upper tract urothelial carcinoma : A multi-institutional study. / Mathieu, Romain; Klatte, Tobias; Margulis, Vitaly; Karam, Jose A.; Rouprêt, Morgan; Seitz, Christian; Karakiewicz, Pierre I.; Fajkovic, Harun; Wood, Christopher G.; Weizer, Alon Z.; Raman, Jay; Remzi, Mesut; Rioux-Leclercq, Nathalie; Haitel, Andrea; Bensalah, Karim; Lotan, Yair; Rink, Michael; Kluth, Luis A.; Scherr, Douglas S.; Robinson, Brian D.; Shariat, Shahrokh F.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 33, No. 11, 01.11.2015, p. 495.e15-495.e22.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Survivin is not an independent prognostic factor for patients with upper tract urothelial carcinoma

T2 - A multi-institutional study

AU - Mathieu, Romain

AU - Klatte, Tobias

AU - Margulis, Vitaly

AU - Karam, Jose A.

AU - Rouprêt, Morgan

AU - Seitz, Christian

AU - Karakiewicz, Pierre I.

AU - Fajkovic, Harun

AU - Wood, Christopher G.

AU - Weizer, Alon Z.

AU - Raman, Jay

AU - Remzi, Mesut

AU - Rioux-Leclercq, Nathalie

AU - Haitel, Andrea

AU - Bensalah, Karim

AU - Lotan, Yair

AU - Rink, Michael

AU - Kluth, Luis A.

AU - Scherr, Douglas S.

AU - Robinson, Brian D.

AU - Shariat, Shahrokh F.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Objective: Several small single-center studies have reported conflicting results on the prognostic value of survivin expression in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy. We attempted to validate the prognostic utility of survivin using a large multi-institutional cohort. Material and methods: Survivin expression was evaluated by immunohistochemistry in tumor tissue from 732 patients with unilateral, sporadic UTUC treated with radical nephroureterectomy between 1990 and 2008 at 7 centers. Survivin expression was considered altered when at least 10% of the tumor cells stained positive. Associations of altered survivin expression with recurrence-free survival (RFS) and cancer-specific survival (CSS) were evaluated using Cox proportional hazards regression models. Results: Altered survivin expression was observed in 288 (39.3%) tumors and was associated with more advanced pathological tumor stages ( P<0.001), lymph node metastases ( P<0.001), lymphovascular invasion ( P<0.001), tumor necrosis ( P = 0.027), and tumor architecture ( P<0.001). Median follow-up was 35 (16-64) months. There were 191 (25.4%) patients who experienced disease recurrence, and 165 patients (21.9%) died of the disease. In the univariable analysis, altered survivin expression was significantly associated with worse RFS and CSS (each P<0.001); however, altered survivin expression did not achieve independent predictive status on multivariable models ( P = 0.24 and P = 0.53). Similarly, survivin was not independently associated with outcomes in subgroup analyses, including patients with high-grade tumors. Conclusions: In UTUC, altered survivin expression is associated with worse clinicopathological features and worse RFS and CSS. However, it does not appear to be independently associated with cancer outcomes when considering standard prognostic factors.

AB - Objective: Several small single-center studies have reported conflicting results on the prognostic value of survivin expression in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy. We attempted to validate the prognostic utility of survivin using a large multi-institutional cohort. Material and methods: Survivin expression was evaluated by immunohistochemistry in tumor tissue from 732 patients with unilateral, sporadic UTUC treated with radical nephroureterectomy between 1990 and 2008 at 7 centers. Survivin expression was considered altered when at least 10% of the tumor cells stained positive. Associations of altered survivin expression with recurrence-free survival (RFS) and cancer-specific survival (CSS) were evaluated using Cox proportional hazards regression models. Results: Altered survivin expression was observed in 288 (39.3%) tumors and was associated with more advanced pathological tumor stages ( P<0.001), lymph node metastases ( P<0.001), lymphovascular invasion ( P<0.001), tumor necrosis ( P = 0.027), and tumor architecture ( P<0.001). Median follow-up was 35 (16-64) months. There were 191 (25.4%) patients who experienced disease recurrence, and 165 patients (21.9%) died of the disease. In the univariable analysis, altered survivin expression was significantly associated with worse RFS and CSS (each P<0.001); however, altered survivin expression did not achieve independent predictive status on multivariable models ( P = 0.24 and P = 0.53). Similarly, survivin was not independently associated with outcomes in subgroup analyses, including patients with high-grade tumors. Conclusions: In UTUC, altered survivin expression is associated with worse clinicopathological features and worse RFS and CSS. However, it does not appear to be independently associated with cancer outcomes when considering standard prognostic factors.

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U2 - 10.1016/j.urolonc.2015.06.016

DO - 10.1016/j.urolonc.2015.06.016

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