OBJECTIVE To explore the expression of the MDR1/P-glycoprotein, Fas and survivin and to examine their correlation with the biologic behavior of bladder transitional cell carcinoma (BTCC).METHODS Immunohistochemistry was used to examine the expression of P-gp, survivin and Fas in BTCC (n=64) and normal bladder mucosa (n=12).RESULTS The expression level of P-gp and survivin in BTCC was higher compared to normal bladder mucosa (P＜0.01) and their expression was strongly correlated with clinical grading (P＜0.01). In BTCC and normal bladder mucosa Fas expression was 50% and 100%, respectively (P＜0.01). Recurrent BTCC showed higher expression than primary BTCC (P＜0.01) and the expression of P-gp in BTCC had a reverse correlation with Fas expression but no correlation with survivin expression.CONCLUSUON The MDR of BTCC was strongly correlated with the expression of P-gp and Fas, but was not correlated with survivin expression. Thus, enhancing cancer sensitivity to chemotherapy by reversing multidrug resistance with reversal agents or up-regulating Fas expression by apoptotic enhancing agents, might be a potential therapy to prevent tumor recurrence and invasiveness.