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Shannon D. Smith, MD; Marcia A. Wheeler, MS; Janet Plescia, BS; John W. Colberg, MD; Robert M. Weiss, MD; Dario C. Altieri, MD

JAMA. 2001;285:324-328.

Context  Dysregulation of apoptosis may favor onset and progression of cancer and influence response to therapy. Survivin is an inhibitor of apoptosis that is selectively overexpressed in common human cancers, but not in normal tissues, and that correlates with aggressive disease and unfavorable outcomes.

Objective  To investigate the potential suitability of survivin detection in urine as a novel predictive/prognostic molecular marker of bladder cancer.

Design, Setting, and Patients  Survey of urine specimens from 5 groups: healthy volunteers (n = 17) and patients with nonneoplastic urinary tract disease (n = 30), genitourinary cancer (n = 30), new-onset or recurrent bladder cancer (n = 46), or treated bladder cancer (n = 35), recruited from 2 New England urology clinics.

Main Outcome Measures  Detectable survivin levels, analyzed by a novel detection system and confirmed by Western blot and reverse transcriptase polymerase chain reaction (RT-PCR), in urine samples of the 5 participant groups.

Results  Survivin was detected in the urine samples of all 46 patients with new or recurrent bladder cancer using a novel detection system (31 of 31) and RT-PCR (15 of 15) methods. Survivin was not detected in the urine samples of 32 of 35 patients treated for bladder cancer and having negative cystoscopy results. None of the healthy volunteers or patients with prostate, kidney, vaginal, or cervical cancer had detectable survivin in urine samples. Of the 30 patients with nonneoplastic urinary tract disease, survivin was detected in 3 patients who had bladder abnormalities noted using cystoscopy and in 1 patient with an increased prostate-specific antigen level. Patients with low-grade bladder cancer had significantly lower urine survivin levels than patients with carcinoma in situ (P = .002).

Conclusions  Highly sensitive and specific determination of urine survivin appears to provide a simple, noninvasive diagnostic test to identify patients with new or recurrent bladder cancer.

Author Affiliations: Departments of Surgery (Drs Smith, Colberg, and Weiss, and Ms Wheeler) and Pathology (Ms Plescia and Dr Altieri), Boyer Center for Molecular Medicine, Yale University School of Medicine, New Haven, Conn.

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