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Background The  BIRC5  gene encodes for the Survivin protein, which is a member of the inhibitor of apoptosis family. Survivin is found in humans during fetal development, but generally not in adult cells thereafter. Previous studies have shown that Survivin is abundant in most cancer cells, thereby making it a promising target for anti-cancer drugs and a potential prognostic tool. Methods To assess genetic alterations and mutations in the  BIRC5  gene as well as  BIRC5  co-expression with other genes, genomic and transcriptomic data were downloaded via cBioPortal for approximately 9000 samples from The Cancer Genome Atlas (TCGA) representing 33 different cancer types and 11 pan-cancer organ systems, and validated using the ICGC Data Portal and COSMIC. TCGA  BIRC5  RNA sequencing data from 33 different cancer types and matching normal tissue samples for 16 cancer types were downloaded from Broad GDAC Firehose and validated using breast cancer microarray data from our previous work and data sets from the GENT2 web-based tool. Survival data were analyzed with multivariable Cox proportional hazards regression analysis and validated using KM plotter for breast-, ovarian-, lung- and gastric cancer. Results Although genetic alterations in  BIRC5  were not common in cancer,  BIRC5  expression was significantly higher in cancer tissue compared to normal tissue in the 16 different cancer types. For 14/33 cancer types, higher  BIRC5  expression was linked to worse overall survival (OS, 4/14 after adjusting for both age and tumor grade and 10/14 after adjusting only for age). Interestingly, higher  BIRC5  expression was associated with better OS in lung squamous cell carcinoma and ovarian serous cystadenocarcinoma. Higher  BIRC5  expression was also linked to shorter progressive-free interval (PFI) for 14/33 cancer types (4/14 after adjusting for both age and tumor grade and 10/14 after adjusting only for age). External validation showed that high  BIRC5  expression was significantly associated with worse OS for breast-, lung-, and gastric cancer. Conclusions Our findings suggest that  BIRC5  overexpression is associated with the initiation and progression of several cancer types, and thereby a promising prognostic biomarker.

Pan-cancer analysis identifies BIRC5 as a prognostic biomarker