The Prognostic Value of CD44 Expression in Epithelial-Mesenchymal Transition: Preliminary Data from Patients with Gastric and Esophageal Cancer

Background: Epithelial-mesenchymal transition is one of the mechanisms that contribute to the aggressiveness of cancer. CD44 antigen is an emerging biomarker that is currently being evaluated in the literature in the frame of epithelial-mesenchymal transition. The aim of this study was to evaluate the expression of CD44 in relation to several clinicopathological parameters in gastric and esophageal carcinomas. Materials and Methods: This historical cohort survey was performed on gastric and esophageal tumors obtained from 86 patients who underwent resection from 2003 until 2011. Immunohistochemistry was used for assessing the expression of CD44 with a semiquantitative model. Results: Survival rates were negatively correlated with pT at diagnosis (p<0.01), pN (p<0.01), positive lymph node ratio (p<0.01), pM (p=0.004), tumor stage (p<0.01) and grade (p<0.01), and the absence of R0 resection (p<0.01). Disease-free survival rates were affected by pN at diagnosis (p=0.02), positive lymph node ratio (p=0.03) and tumor stage (p=0.02). The correlation of tissue CD44 expression with overall and disease-free survival was not statistically significant, whereas tumor T, N, positive lymph node ratio and lymphovascular invasion were significantly associated with CD44 positivity. Moreover, tissue CD44 expression was not significantly associated with stage, histological subtype according to Lauren classification, the patient's age or gender. Conclusion: CD44 antigen expression might be an indicative and descriptive marker of epithelial-mesenchymal transition, mainly in gastric cancer, reflecting diverse clinicopathological events.