Utility of SOX2 and Livin Co-Expression in the Prognosis of Bladder Cancer With Bilharzial and Non-Bilharzial Bladder Status

BACKGROUND The aim of this study was to investigate the expression of SOX2, a key transcription factor and livin, an apoptotic inhibitor in bladder transitional cell carcinoma (TCC) and squamous cell carcinoma (SCC). Moreover, their prognostic significance was assessed. METHODS The expressions of SOX2 and livin in 82 TCC and 35 SCC cases were detected by immunohistochemistry. RESULTS SOX2 and livin were over-expressed in tumor tissues as compared to the corresponding adjacent non-neoplastic tissues. SOX2 and livin expressions were significantly associated with high tumor grade (P = 0.002 and P = 0.007, respectively) and high tumor stage (P = 0.027 and P = 0.033, respectively). No significant correlation was found between tumor and other clinicopathological factors such as age, gender and schistosomal status. Univariate analysis revealed that TCC and SCC patients with high SOX2 or livin expressions were significantly related to overall survival (P < 0.001, P = 0.025 for TCC patients and P = 0.041, P = 0.021 for SCC patients, respectively). Multivariate survival analysis further demonstrated that SOX2 expression was an independent prognostic factor for TCC patients (P = 0.015). CONCLUSIONS SOX2 and livin may contribute to the progression of bladder carcinoma. SOX2/livin pathway regulates cancer stem cell survival so it could be targeting as an effective therapeutic strategy for cancer treatment.