ORIGINAL ARTICLE High survivin expression as a predictor of poor response to preoperative chemoradiotherapy in locally advanced rectal cancer Kyubo Kim & Eui Kyu Chie & Hong-Gyun Wu & Sang Gyun Kim & Seung-Hee Lee & Gyeong Hoon Kang & Chang Lim Hyun & Sung W. Ha Accepted: 3 March 2011 /Published online: 19 March 2011 # Springer-Verlag 2011 Abstract Purpose To evaluate seven molecular markers including cyclooxygenase -2, epidermal growth factor receptor, Ki-67, p21, survivin, thymidylate synthase, and vascu- lar endothelial growth factor for prediction of response to preoperative chemoradiotherapy in locally advanced rectal cancer. Materials and methods Fifty-four patients with clinical T3- 4 and/or node-positive rectal cancer who underwent preoperative chemoradiotherapy followed by surgical resection were enrolled into this study. Preoperative chemo- radiotherapy consisted of 50.4 Gy of pelvic irradiation with concomitant 5-fluorouracil or oral capecitabine. Expression of molecular markers in pretreatment paraffin-embedded tumor biopsy specimens was assessed by immunohisto- chemical staining on the tissue microarray. Tumor down- staging was used as an endpoint for evaluation of tumor response. Results Tumor downstaging was observed in 22 patients (41%), and pathologic complete remission in 7 patients (13%). Among seven molecular markers, only survivin expression was significantly related with tumor down- staging: 26% with high survivin expression (>75% in extent) vs. 72% with low survivin expression (p =0.0011). However, other six molecular markers were found not to have any correlation with tumor downstaging. Conclusions High survivin expression in pretreatment tumor biopsy was associated with less tumor downstaging after preoperative chemoradiotherapy for locally advanced rectal cancer. Keywords Rectal cancer . Preoperative chemoradiotherapy . Molecular marker . Survivin Introduction Preoperative radiotherapy with or without chemotherapy has become a standard treatment for locally advanced rectal cancer [1]. Compared with postoperative treatment, preop- erative radiotherapy has the advantage of potentially increased probability of sphincter preservation, lower local recurrence rate, and less treatment-related toxicity [2]. Although pathologic response is well known to be associated with the prognosis, the degree of response to K. Kim : E. K. Chie : H.-G. Wu (*) : S.-H. Lee : S. W. Ha Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110–744, Republic of Korea e-mail: wuhg@snu.ac.kr S. G. Kim Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea G. H. Kang : C. L. Hyun Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea H.-G. Wu : S.-H. Lee : S. W. Ha Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea H.-G. Wu : S. W. Ha Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea Int J Colorectal Dis (2011) 26:1019–1023 DOI 10.1007/s00384-011-1180-1