Survivin as a Prognostic Marker in Breast Cancer




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Purpose: Breast cancer is the second leading cause of cancer-related death for women in the United States and continues to pose a threat to millions of women globally. Incidence rates of breast cancer continue to rise across ethnic/ racial groups and survival rates continue to increase with the development of screening protocols and targeted therapeutics. However, despite the advances in disease diagnosis and management a racial disparity continues to be evident. Even with advanced therapeutics and the development of various prognostic markers, Black women continue to have higher rates of breast cancer mortality when compared to other racial groups. Mortality is also correlated with the status of metastasis, as advanced disease points to poor outcomes and survival rates. The evident racial disparity and advanced staging reflect the need for new and more efficient prognostic markers to be developed to better manage and treat breast cancer. Existing prognostic factors include immunohistochemical markers such as estrogen receptor, progesterone receptor, Ki-67, and human epidermal growth factor receptor-2. One potential immunohistochemical marker is the Inhibitor of Apoptosis Protein (IAP), survivin, with elevated levels of expression found in various cancer types, including breast cancer. Previous research has linked elevated levels of survivin expression with increased resistance to therapeutics like chemotherapy and radiation. However, there remains some question of the true clinical significance of survivin as a prognostic factor. The objective of this literature review is to provide an overview of research on the use of survivin expression as a clinically useful prognostic marker in breast cancer. Methods: Relevant research articles were collected mainly through the PubMed database. Studies investigating survivin expression alone or with other prognostic markers of breast cancer using immunohistochemistry or PCR analysis of breast tumor tissue were selected. Results: Review of this literature showed that the majority of studies found a significant correlation between levels of survivin expression and poor prognosis. Fourteen studies from the total seventeen analyzed identified various established prognostic markers to be correlated with survivin expression. Increased levels of survivin were associated with poor prognosis through findings of higher grade, greater lymph node metastasis, increased proliferation, and other indicators. Conclusion: These findings suggest that survivin has the potential to be used clinically in combination with other biomarkers to bolster diagnostics. In addition, the results indicate that survivin may be used as a marker in disease management as well as a unique focus of targeted therapy.