Ewha Med J.  2018 Jul;41(3):63-74. 10.12771/emj.2018.41.3.63.

Expression of CD44 according to Clinicopathologic Characteristics of Gastric Cancer

• Ryu MS
• Park HJ
• Moon CM
• Kim SE
• Jung HK
• Shim KN
• Jung SA
• Cho MS

• KMID: 2417943
• DOI: http://doi.org/10.12771/emj.2018.41.3.63

Abstract

OBJECTIVES
Cancer stem cells are defined as focal cluster of cells within a tumor that possess the capacity for self-renewal and differentiation into phenotypically heterogeneous cells. Cluster of differentiation 44 (CD44) is considered one of the gastric cancer stem cell markers. We aimed to investigate how the expression of CD44 varies according to the clinicopathologic characteristics in gastric cancer.
METHODS
For this study, 157 patients who received an operation due to gastric cancer between May 1998 and December 2009 were selected. CD44 immunohistochemistry was reviewed using the semi-quantitative scoring of intensity and proportion. The sum of the intensity and proportion scores was calculated, and a score of 2 or less was deemed "˜CD44-negative' and 3 or more as "˜CD44-positive.'
RESULTS
Among the final 143 subjects, 69 (48.3%) were CD44 positive. Older age, intestinal type gastric cancer, lymphatic invasion, and lymph node metastasis were significantly correlated with expression of CD44. In the multivariate analysis, older age was the only independent factor associated with CD44 expression (P=0.028). CD44 expression was correlated with overall survival, 5-year survival, and disease-free survival. In the multivariate analysis, older age, male gender, and lymphatic invasion were independent predictors of poor overall survival. Also, older age and lymphatic invasion were significant factors in 5-year survival, and lymphatic invasion was an independent factor of poor disease-free survival.
CONCLUSION
Older age (≥60 years) was independently associated with CD44 expression in gastric cancer patients. Also, CD44 expression was correlated with poor prognosis in gastric cancer patients.

Keyword

Neoplastic stem cells; Cluster of differentiation 44; Stomach neoplasms; Prognosis

MeSH Terms

Disease-Free Survival
Humans
Immunohistochemistry
Lymph Nodes
Male
Multivariate Analysis
Neoplasm Metastasis
Neoplastic Stem Cells
Prognosis
Stem Cells
Stomach Neoplasms*

Figure

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  Fig. 1 Flow chart of patient selection for this study. WD, well differentiated; MD, moderately differentiated; PD, poorly differentiated; UD, undifferentiated; SRC, signet ring cell carcinoma.

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  Fig. 2 Intensity of CD44 immunohistochemical staining for gastric cancer (×200). (A) 0, no staining; (B) 1, weak staining; (C) 2, moderate staining; and (D) 3, strong staining.

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  Fig. 3 Clinicopathologic factors associated with overall survival. (A) Age, (B) sex, (C) Lauren classification, (D) vascular invasion, (E) lymphatic invasion, (F) perineural invasion, (G) TNM stage, and (H) CD44 expression.

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  Fig. 4 Clinicopathologic factors associated with 5-year survival. (A) Age, (B) sex, (C) Lauren classification, (D) vascular invasion, (E) lymphatic invasion, (F) perineural invasion, (G) TNM stage, and (H) CD44 expression.

• 

  Fig. 5 Clinicopathologic factors associated with disease-free survival. (A) Age, (B) sex, (C) Lauren classification, (D) vascular invasion, (E) lymphatic invasion, (F) perineural invasion, (G) TNM stage, and (H) CD44 expression.

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