Objective  This study aims to investigate the expression of survivin in advanced non-small cell lung cancer (NSCLC), as well as to analyze the relationship of survivin expression with cisplatin cis diamminedichloroplatinum (Ⅱ), CDDP sensitivity in vitro and in vivo.

  Methods  The expression of survivin mRNA and protein in A549 as well as A549/DDP cells was measured by reverse transcription-polymerase chain reaction (RT PCR) and Western blot analyses, respectively. A549/CDDP cell apoptosis was detected by flow cytometry following transfection with survivin siRNA. The 3(4, 5 dimethylthiazol 2 yl) -2, 5diphenyltetrazolium bromide assay, was also performed to determine the cell viability, half-maximum inhibitory concentration (IC50), and CDDP content. The resistance index (RI) was then calculated. Survivin expression in advanced NSCLC tissues was detected by immunohistochemical and RT PCR assays.

  Results  The expression levels of survivin mRNA and protein were both significantly higher in A549 / CDDP cells than in A549 cells (P < 0.01). The survivin mRNA and protein levels were markedly decreased in A549 / CDDP cells transfected with survivin siRNA. The cell growth inhibition rate in the survivin siRNA + CDDP group was 76.4 %, the IC50 value was 34.12±3.55 pg/mL, and the RI was reduced to 6.7 l, which was significantly lower compared with the control group (P < 0.05). The apoptotic rate was 37.12 % ±3.23 % in the survivin siRNA + CDDP group, which was higher compared with the control group (P < 0.01). The response rate (RR) to chemotherapy was higher in the survivin negative group than in the positive group (44.4 % versus 19.3 %; P < 0.01). Both the overall survival and time to progression were longer in the survivin-negative group than in the survivin positive group. No significant difference was found between the two groups (P > 0.05). Cox multivariate regression analysis showed that the survivin expression level was not an independent prognostic factor. The RR was higher in the low - level survivin mRNA and survivin protein-negative groups than in the high-level survivin mRNA and survivinpositive groups (60 % versus 10 %; 66.7 % versus 9 %).

  Conclusion  Survivin overexpression contributes to the drug resistance to CDDP. The high expression of survivin gene is closely associated with poor survival and lower RR. Thus, survivin is an ideal predictor of CDDP sensitivity in advanced NSCLC patients.