Background:-Aggressiveness of neoplasm may be linked to the biological characteristic of tumor cells, represented by the level of expression of specific molecular markers. Aim: was to examine the coexpression of survivin, COX-2, DNA ploidy and S phase fraction (SPF) in colorectal carcinomas and assess its prognostic value. Material and Methods:-neoplastic tissue from 100 patients with primary non treated colorectal adenocarcinomas were assessed by immunohistochemistry and flow cytometry. Statistical analysis evaluated the correlation of marker expression with clinicopathological variables and with the expression of other markers. Results:-Survivin and COX-2 cytoplasmic immunoreactivity was detected in 65% and 73% respectively of the studied adenocarcinomas. Flow cytometry revealed that 62% of carcinomas were aneupliod and 47% had high SPF. COX-2, DNA aneuploidy and high SPF showed significantly association with lymph nodes (LN) involvement and Dukes' stage (P = 0.04, P = 0.02 and 0.03, respectively for LN and P = 0.03, P = 0.01 and 0.04, respectively for Dukes' stage). DNA aneuploidy was positively associated with histological grade (P = 0.03). High SPF and DNA aneuploidy were positively associated with tumor localization (P = 0.03 for both). COX-2 displayed positive association with survivin expression and with recurrence (P = 0.04 and P = 0.02 respectively). High SPF significantly associated with survivin, COX-2 and DNA ploidy (P = 0.005, P = 0.004 and 0.02, respectively). The expression of more markers by each carcinoma was positively correlated with LN involvement (P = 0.04) and advanced stage (P = 0.001). Conclusions: Our analysis demonstrate that the score of markers co-expression correlates significantly with the poor prognosis of patients with colorectal adenocarcinomas.

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