Background Dysregulation of apoptosis has been implicated not only in carcinogenesis and tumor progression butalso in tumor recurrence.We investigated whether the expression of X-linked inhibitor of apoptosis (XIAP) might predictearly recurrence in patients with non-muscular invasive bladder cancer.Methods The cohort comprised 176 consecutive patients with primary superficial bladder cancer treated withtransurethral resection.Immunohistochemical staining using the standard avidin-biotin-peroxidase technique andRT-PCR were used to detect XIAP protein and mRNA expressions in cancer tissues.The relationship between XIAPexpression and clinicopathological characteristics,cancer recurrence were analyzed.Results XIAP expression was observed in 108 cases (61.4%) and no expression in 68.There was no correlationbetween XIAP expression rate and the tumor pathological grade,but was an apparent trend toward the increased XIAPlevels from well (G1) to poor (G3) differentiated cancer.Eighty-two (46.6%) patients experienced tumor recurrence at amean of 28.6 months of the follow-up;66 of them expressed XIAP (61.1%) and 16 were XIAP negative (23.5%).Twelvepatients presented with invasive disease at the time of relapse and all of them expressed XIAP.Patients without XIAPexpression or with low tumor grades had significantly higher recurrence-free survival than those with XIAP expression(log rank test P=-0.0015) or high tumor grades (log rank test P<0.001).Multivariate analysis revealed that XIAPexpression,tumor grade,and tumor number were independent predictors for the recurrence of non-muscular invasivebladder cancer (P=0.004,0.016,and 0.043,respectively).Conclusions XIAP may be considered as a new independent prognostic marker for early recurrence of non-muscularinvasive bladder cancer. Background Dysregulation of apoptosis has been implicated not only in carcinogenesis and tumor progression butalso in tumor recurrence. We investigated whether the expression of X-linked inhibitor of apoptosis (XIAP) might predictearly recurrence in patients with non-muscular invasive bladder cancer. Methods The cohort 176 consecutive patients with primary superficial bladder cancer treated with transurethral resection. Immunohistochemical staining using the standard avidin-biotin-peroxidase technique and RT-PCR were used to detect XIAP protein and mRNA expressions in cancer tissues. The relationship between XIAPexpression and clinicopathological characteristics, cancer recurrence were analyzed. Results XIAP expression was observed in 108 cases (61.4%) and no expression in 68.There was no correlation between XIAP expression rate and the tumor pathological grade, but was an apparent trend toward the increased XIAPlevels from well (Gl) to poor (G3) differentiated cancer.Eighty-two (46.6% ) patients experienced tumor recurrence at amean of 28.6 months of the follow-up; 66 of them XIAP (61.1%) and 16 were XIAP negative (23.5%). Twelvepatients presented with invasive disease at the time of relapse and all of them expressed XIAP.Patients without XIAPexpression or with low tumor grades had significantly higher recurrence-free survival than those with XIAP expression (log rank test P = -0.0015) or high tumor grades (log rank test P <0.001) .Multivariate analysis revealed that XIAPexpression, tumor grade, and tumor number were independent predictors for the recurrence of non-muscular invasive bladder cancer (P = 0.004, 0.016, and 0.043, respectively) .Conclusions XIAP may be considered as a new independent prognostic marker for early recurrence of non-muscular invasive bladder cancer.