We investigated the association of survivin expression with prognosis and other apoptosis-related biological factors in 110 primary ovarian cancer patients admitted to the Division of Gynecologic Oncology, Catholic University of Rome. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded sections by using polyclonal antibody ab469 for survivin, and mouse monoclonal antibodies (clone 124 and DO-7), for bcl-2 and p53, respectively. Cytoplasmic survivin immunoreaction was observed in 84.5% cases, while nuclear survivin immunostaining was observed in 29.1% cases. We failed to find any relationship between cytoplasmic survivin positivity rate and any of the parameters examined. Serous tumours showed a lower percentage of nuclear survivin positivity with respect to other histotypes (20.5 vs 48.6%, respectively; P-value ¼ 0.004). The percentage of nuclear survivin positivity was higher in cases subjected to primary tumour cytoreduction (43.5%), with respect to patients subjected to exploratory laparotomy (20%) (P ¼ 0.024). Bcl-2 and p53 were, respectively, expressed in 27.3 and 60.0% of the cases and their expression was not correlated with survivin status. During the follow-up period, progression and death of disease were observed in 68 (61.8%) and 53 (48.2%) cases, respectively. There was no difference in time to progression and overall survival according to survivin status in ovarian cancer patients. In conclusion, in our experience, the immunohistochemical assessment of survivin status does not seem to be helpful in the prognostic characterisation of ovarian cancer. A more in depth investigation of the complex physiology of divergent survivin variants is needed in order to clarify the biological and the clinical role of differentially located survivin isoforms. (Hoskins et al, 2000), it is conceivable that the assessment of biochemical factors more strictly related to tumour cell biology and intrinsic aggressiveness could help identifying high-risk patients and facilitating management of this disease.Apoptosis (programmed cell death) has been proposed to play a role not only in cancer onset and progression but also in sustaining decreased tumour cell sensitivity to chemotherapy (Hickman, 1992;Thompson, 1995), which still represents one of the main prognostic indicators in this neoplasia (Hoskins et al, 2000). In this context, the analysis of the molecules possibly involved in the modulation of apoptosis seems to be particularly attractive.Survivin is a member of the inhibitors of apoptosis protein (IAP) family, which participates in the complex network regulating programmed cell death and also cell division (Ambrosini et al, 1997;Altieri and Marchisio, 1999;Salvesen and Duckett, 2002). Survivin protein is commonly detected in fetal tissues but not in normal adult tissues, while being overexpressed in human cancer, thus suggesting the contribution of survivin gene reactivation in carcinogenesis (Ambrosini et al, 1997). The crucial role of survivin in protection from apoptosis is supported by the o...