Survivin is an inhibitor of apoptosis. Aberrant survivin expression occurs in malignant tumors and has often been linked to unfavorable patient outcome. Here we analyzed 12 432 prostate cancers by immunohistochemistry. Survivin immunostaining was regularly expressed at high levels in normal prostate epithelium but expression was often reduced in prostate cancers. Among 9492 evaluable prostate cancers, 9% expressed survivin strongly, 19% moderately, 28% weakly, and 44% lacked it. Loss of cytoplasmic survivin was seen in advanced tumor stage, higher Gleason score, preoperative PSA levels, and Ki-67 labeling index, and associated with earlier PSA recurrence (P < .0001). Survivin loss was significantly more common in cancers carrying TMPRSS2:ERG fusions (61% survivin negative) than in ERG wild-type cancers (32% survivin negative; P < .0001). Multivariate analysis revealed that reduced cytoplasmic survivin expression predicted poor prognosis independent from Gleason score, pT, pN, and serum PSA level. This was valid for ERG-positive and ERG-negative cancers. Survivin expression loss even retained its prognostic impact in 1020 PTEN deleted cancers, a group that is already characterized by dismal patient prognosis. In conclusion, reduced survivin expression is associated with more aggressive tumors and inferior prognosis in prostate cancer.

中文翻译：

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细胞质存活蛋白表达的丧失是根治性手术前列腺癌患者预后不良的独立预测因素。

Survivin 是细胞凋亡的抑制剂。异常的存活蛋白表达发生在恶性肿瘤中，并且通常与不利的患者预后有关。在这里，我们通过免疫组织化学分析了 12 432 例前列腺癌。Survivin 免疫染色在正常前列腺上皮中经常高水平表达，但在前列腺癌中表达经常降低。在 9492 例可评估的前列腺癌中，9% 强烈表达 survivin，19% 中度表达，28% 弱表达，44% 缺乏。在晚期肿瘤分期、较高的 Gleason 评分、术前 PSA 水平和 Ki-67 标记指数中观察到细胞质存活蛋白的丧失，并且与较早的 PSA 复发相关（P < .0001）。与 ERG 野生型癌症（32% 存活蛋白阴性；P < .0001）相比，携带 TMPRSS2:ERG 融合蛋白的癌症（61% 存活蛋白阴性）中存活蛋白丢失明显更常见。多变量分析显示，细胞质存活蛋白表达降低可预测预后不良，而与 Gleason 评分、pT、pN 和血清 PSA 水平无关。这对 ERG 阳性和 ERG 阴性癌症有效。Survivin 表达缺失甚至在 1020 个 PTEN 缺失的癌症中保留了其预后影响，该组已经以患者预后不佳为特征。总之，存活蛋白表达降低与前列腺癌更具侵袭性的肿瘤和较差的预后相关。一个已经以患者预后不佳为特征的群体。总之，存活蛋白表达降低与前列腺癌更具侵袭性的肿瘤和较差的预后相关。一个已经以患者预后不佳为特征的群体。总之，存活蛋白表达降低与前列腺癌更具侵袭性的肿瘤和较差的预后相关。