Abstract
ObjectivesThe expression of survivin, an inhibitor of apoptosis, in tumor cells is associated with poor clinical outcome for various cancers. We conducted this study to determine survivin expression in patients with adenoid cystic carcinoma (ACC) of the head and neck and to identify its clinical significance as a prognostic factor.Materials and methodsWe performed immunohistochemical staining for survivin, p53, bcl-2 protein, and Ki-67 in formalin fixed, paraffin-embedded blocks from 37 cases of head and neck ACC. We also reviewed the patients' clinical records to determine the association of staining with clinical course.ResultsOf the 37 cases of head and neck ACC, 31 (83.8%) were positive for cytoplasmic survivin expression, and 23 (62.2%) were positive for nuclear survivin expression. There was a significant association between nuclear survivin expression and bcl-2 (P = 0.031). A larger tumor was more commonly a survivin-positive tumor (cytoplasmic survivin, P = 0.043; nuclear survivin, P = 0.057). Median overall survival (OS) was significantly longer in patients not expressing nuclear survivin (P = 0.035). A multivariate analysis revealed that nuclear survivin expression significantly impacted OS (hazard ratio 8.567, P = 0.018) in addition to lymph node involvement (hazard ratio 7.704, P = 0.016).ConclusionsThe immunohistochemical expression of nuclear survivin has a prognostic impact in patients with head and neck ACC. These results suggest that nuclear survivin expression may be a useful biomarker for predicting prognosis in patients with head and neck ACC who were treated with surgical resection.
Highlights
Adenoid cystic carcinoma (ACC) is an uncommon epithelial tumor that constitutes about 10% of all head and neck tumors
There was a significant association between nuclear survivin expression and bcl-2 (P = 0.031)
A multivariate analysis revealed that nuclear survivin expression significantly impacted overall survival (OS) in addition to lymph node involvement
Summary
Adenoid cystic carcinoma (ACC) is an uncommon epithelial tumor that constitutes about 10% of all head and neck tumors. Unlike squamous cell head and neck cancer (HNSCC), ACC has been described as a tumor with indolent but persistent and recurrent growth and late onset of metastases, which eventually leads to death [1]. Additional predictors of ACC biologic activity might prove helpful for the clinical management of patients and could be a target of molecular therapy. Biologic prognostic factors including KIT, epidermal growth factor receptor, human epidermal growth receptor-2, estrogen and progesterone receptors, proliferating cell nuclear antigen, Ki-67, and the p53, bcl-2 and SOX-4 genes, have been extensively investigated and are candidates for targeted therapy [4]. The results from studies on the effectiveness of several molecular targeted therapies for salivary gland ACC have been disappointing. More studies are needed for current molecular targeted therapy and further research into novel molecular targets is urgently necessary
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