Suppression of apoptosis is important for carcinogenesis and tumor growth. Recent studies revealed that survivin not only inhibited apoptosis but also accelerated cancer cell proliferative activity. To investigate the prognostic role of expression of the antiapoptosis gene,survivin, in hepatocellular carcinoma (HCC), the authors analyzed the correlation between the expression pattern ofsurvivinmessenger RNA (mRNA) and clinicopathologic findings of patients. Tissues were obtained by surgical resection of livers from 51 patients with HCC and 6 patients without HCC. Expression ofsurvivinmRNA was evaluated using reverse transcription-polymerase chain reaction in 51 tumors, 51 adjacent histologically noncancerous livers, and 6 normal livers. Survivin protein expression was evaluated using Western blotting, and apoptotic cancer cells were detected by immunostaining with polyclonal rabbit anti-single-stranded DNA.SurvivinmRNA expression was detected in 21 of 51 (41%) tumors, 2 of 51 (4%) noncancerous livers, and none of the 6 normal livers.SurvivinmRNA expression did not correlate with tumor size or stage of HCC. Percentage of apoptotic cancer cells of 30survivinmRNA-negative tumors (5.2 ± 3.4%) was significantly higher than that of 21survivinmRNA-positive tumors (2.2 ± 2.3%,P= 0.0019). The disease-free 5-year survival rate of 21 patients positive forsurvivinmRNA (19%) was significantly poorer than that of 30 patients negative forsurvivinmRNA (39%,P= 0.0148).SurvivinmRNA was detected in 57% (17/30) patients with HCC recurrence but in only 19% (4/21) of patients without recurrence (P= 0.0072). These results indicated thatsurvivinmRNA expression could be used as an independent prognostic factor for patients with HCC after hepatectomy.