Nuclear and cytoplasmic expression of survivin in breast carcinoma: Correlation with clinicopathological parameters

Abstract

Background: Survivin, a member of the inhibitor of apoptotic protein family is involved in cell proliferation and apoptotic suppression. Survivin is highly expressed in many cancers and correlated with more aggressive disease. Objective: Assessment of survivin expression in breast carcinoma and its association with clinicopathological factors. Materials and Methods: One hundred and eight breast carcinoma and 22 control benign specimens were used for survivin immunohistochemical assessment. Survivin expression was evaluated according to staining intensity and percentage of positive cells. A numerical score was calculated by multiplying them. Cases with scores of $1 were considered positive. Results: Survivin expression was obviously higher in malignant cases compared to the control cases (p<0.001). Among the clinicopathological parameters analyzed, significant correlations were established with the patient’s age (p<0.001), the size of the tumors (p = 0.005) and HER2 status (p = 0.05). Cytoplamic staining was detected in all positive cases, either alone (62.0%) or associated with nuclear staining (38.0%). Cytoplasmic staining only was significantly correlated with good prognostic parameters; small sized tumor, grade II, ER-positive and HER2-negative tumors (p<0.05). All triple negative cases (100%), 90% of luminal B and 72.2% of HER2 subtype showed survivin positivity, while only 48.7% of luminal A was positive. The association between survivin expression and molecular classification was insignificant (p = 0.069). Conclusion: Survivin has a potential role in diagnosis of malignancy. Survivin expression is associated with younger age, large tumor size, HER2-positive tumor and triple negative molecular subtype. Cytoplasmic staining was correlated with good prognostic parameters.