Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan,
Int J Clin Oncol. 2013 Oct;18(5):869-76. doi: 10.1007/s10147-012-0470-0. Epub 2012 Aug 31.
Chemoradiotherapy (CRT) has been used to improve local control and survival in patients with advanced rectal carcinoma. However, a significant proportion of patients show poor response to adjuvant CRT. We thus investigated the usefulness of survivin expression as a predictive marker of the CRT response and its characteristics.
Forty-three patients with lower rectal cancer who underwent CRT were investigated. All patients received preoperative CRT consisting of TS-1 concurrent with 40 Gy of pelvic irradiation followed by curative resection. The relationship between clinical response, or pathological response, and the expression of survivin of pre-CRT biopsy specimens was evaluated by immunohistochemistry and compared with post-CRT expression.
Positive expression of survivin was observed in 26 of 43 patients (60%) in pre-CRT specimens. Survivin was positively expressed in 77% of stable disease cases, and 43% of partial response (p < 0.05). Regarding the correlation between pathological response and survivin expression, positive expression of survivin was recognized in 75% (18 of 24) of Grade 0 + 1 cases, 50% (7 of 14) of Grade 2 cases, and 20% (1 of 5) of Grade 3 cases. A reverse correlation was recognized between pathological responses and survivin expression (p < 0.05). There were differences in the tumor differentiation between the survivin-positive group and the negative group (p < 0.05). The expression concordance rate was 66% between pre- and post-CRT tissues. In post-CRT tissues, nuclear survivin expression disappeared completely and cytoplasmic expression increased, especially in responder cases.
Survivin expression in biopsy could be an important predictive factor of preoperative CRT response.
放化疗（CRT）已被用于提高晚期直肠癌患者的局部控制率和生存率。然而，相当一部分患者对辅助 CRT 反应不佳。因此，我们研究了生存素表达作为 CRT 反应预测标志物的有用性及其特征。
对 43 例接受 CRT 的低位直肠癌患者进行了研究。所有患者均接受术前 CRT，包括 TS-1 联合 40Gy 盆腔放疗，然后行根治性切除术。通过免疫组织化学评估 CRT 前活检标本的临床反应或病理反应与生存素表达的关系，并与 CRT 后表达进行比较。
43 例 CRT 前标本中，26 例（60%）生存素表达阳性。稳定疾病病例中，生存素阳性表达率为 77%，部分缓解病例为 43%（p<0.05）。关于病理反应与生存素表达的相关性，0+1 级病例中，生存素阳性表达率为 75%（18/24），2 级病例为 50%（7/14），3 级病例为 20%（1/5）。病理反应与生存素表达呈负相关（p<0.05）。生存素阳性组和阴性组的肿瘤分化程度存在差异（p<0.05）。CRT 前后组织的表达一致性率为 66%。在 CRT 后组织中，核生存素表达完全消失，细胞质表达增加，特别是在应答者病例中。
活检中生存素的表达可能是术前 CRT 反应的一个重要预测因子。
