High expression of survivin independently correlates with tumor progression and mortality in patients with skull base chordomas

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OBJECTIVE

The object of this study was to clarify the expression characteristics and prognostic value of survivin in skull base chordomas.

METHODS

In this retrospective study, the authors measured the expression of survivin at the mRNA level in 81 samples from 71 patients diagnosed with skull base chordomas at their hospital in the period from July 2005 to January 2015. Clinical data collection, follow-up, and survival analyses were performed, and correlations were analyzed.

RESULTS

Of the 71 patients, 50 had primary chordomas with a mean survivin expression level of 1.09; the other 21 patients had recurrent chordomas with a mean survivin expression level of 2.57, which was 2.36 times higher than the level in the primary chordoma patients (p < 0.001, Mann-Whitney U-test). In addition, an analysis of 18 paired samples derived from 9 patients showed that the expression level of survivin was 2.62 times higher in recurrent tumors than in primary tumors (p = 0.002, paired t-test). The Spearman rank correlation coefficient method showed that the expression level of survivin was positively correlated with the mean ratio of tumor signal intensity to the signal intensity of surrounding brainstem on T1-weighted sequences (RT1; rs = 0.274, p = 0.021) and was negatively correlated with the mean ratio of tumor signal intensity to the signal intensity of surrounding brainstem on T2-weighted sequences (RT2; rs = −0.389, p = 0.001). A multivariate Cox proportional-hazards model suggested that pathology (p = 0.041), survivin expression level (p = 0.018), preoperative Karnofsky Performance Status (KPS; p = 0.012), and treatment history (p = 0.009) were independent prognostic factors for tumor progression. Survivin expression level (p = 0.008), preoperative KPS (p = 0.019), tumor diameter (p = 0.027), and intraoperative blood loss (p = 0.015) were independent prognostic factors for death.

CONCLUSIONS

Survivin expression level and preoperative KPS were independent significant prognostic factors for tumor progression and death in skull base chordoma patients. Recurrent skull base chordomas and chordomas with high RT1 and low RT2 were likely to have high survivin expression. Other independent risk factors related to tumor progression included conventional pathology and treatment history, whereas additional mortality-related risk factors included larger tumor diameter and greater intraoperative blood loss.

ABBREVIATIONS ELS = expression level of survivin; GTR = gross-total resection; KPS = Karnofsky Performance Status; OS = overall survival; PFS = progression-free survival; PR = partial resection; RCE = ratio of mean signal intensity of tumor to mean signal intensity of surrounding brainstem on contrast-enhanced MRI sequence; RT1 = ratio of mean signal intensity of tumor to mean signal intensity of surrounding brainstem on T1-weighted MRI sequence; RT2 = ratio of mean signal intensity of tumor to mean signal intensity of surrounding brainstem on T2-weighted MRI sequence; SBC = skull base chordoma; STR = subtotal resection.

Article Information

Correspondence Junting Zhang: Beijing Tiantan Hospital, Beijing, People’s Republic of China. zhangjunting2003@aliyun.com.

INCLUDE WHEN CITING Published online January 11, 2019; DOI: 10.3171/2018.8.JNS181580.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Kaplan-Meier analysis showing the prognostic value of treatment history (A), MRI grade (B), pathological type (C), degree of resection (D), survivin expression level (E), and preoperative KPS (F) for tumor progression. Figure is available in color online only.

  • View in gallery

    Kaplan-Meier analysis showing the prognostic value of treatment history (A), survivin expression level (B), preoperative KPS (C), and tumor diameter (D) for mortality. Figure is available in color online only.

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