Expression of Urinary Survivin as a New Tumor Marker for the Detection of Bladder Cancer

Kim, Jun Mo; Lee, Kwang Woo; Kim, Young Ho; Park, Sung Kyu; Lee, Yoo Kyung; Kim, Min Eui

Abstract

PURPOSE: Survivin is a novel member of the inhibitor of apoptosis (IAP) gene family, which is over-expressed in many human tumors include bladder cancer. This prospective study was performed to investigate the clinical usefulness of a test for urinary survivin for the detection of bladder cancer.
MATERIALS AND METHODS
From September 2002 and July 2003, voided urine samples were obtained from 86 healthy volunteers (group 1), from 25 patients having urologic diseases except bladder cancer (group 2), and from 48 patients with bladder cancer (group 3). One patient with small cell carcinoma, and three cases of adenocarcinoma of the bladder were included in group 3. Quantitative measurement of urinary survivin was analyzed using the DuoSet IC enzyme-linked immunosorbent assay (ELISA) kit and a microplate luminometer, DML2000.
RESULTS
The mean urine level of survivin was 7.9pg/ml (1-23) in group 1, 6.0pg/ml (1-12) in group 2 and 63.3pg/ml (1-745) in group 3. Urinary survivin was over-expressed in group 3 more than group 1 and 2 (p<0.01). When we decided that the cut-off value of urinary survivin was to be past the mean 2SD in group 1, the normal upper limit was then 16.5pg/ml. The sensitivity and specificity for the detection of the bladder cancer were 77.1% and 86.8% respectively. The sensitivity and specificity of urinary survivin for urothelial cancer of the bladder were 85.0% and 96.0% respectively. The survivn expression for the high grade tumor was significantly higher than the low grade tumor (p=0.048), but there was no significant difference in the expression of urinary survivin according to the TNM staging (p=0.058).
CONCLUSIONS
The results of our study showed that a diagnostic test with urinary survivin had a high sensitivity and specificity when the cut-off value of survivin was decided to be 16.5pg/ml. This suggests that urinary survivin might be an available tumor marker for the detection of bladder cancer.