| Summary: | 碩士 === 國防醫學院 === 病理及寄生蟲學研究所 === 104 === Aim: Cancer stem cells play essential roles in tumor metastasis and contribute to remarkably negative clinical outcomes. Recently, aldehyde dehydrogenase (ALDH1) and CD44 positivity was identified as a marker of breast cancer stem cells. We evaluated expression of ALDH1 and CD44 protein in normal endometrium, endometrial hyperplasia and endometrial carcinoma, and investigated the prognostic value of ALDH1 and CD44 expression in patients with endometrial carcinoma (EC).
Methods: We conducted a hospital-based retrospective review of ALDH1 and CD44 distribution immunohistochemically in 245 samples of endometrium from biopsy or hysterectomy. ALDH1 and CD44 immunoreactivity was classified into low- and high-score or negative- and positive-score groups based upon the extent and intensity of staining.
Results: A ‘high’ ALDH1 score was observed in a high percentage of samples of EC (44.25%), compared to normal endometrium (4.76%), endometrial hyperplasia without atypia (16.67%) and in endometrial atypical hyperplasia (11.90%). A ‘positive’ CD44 score was observed in a high percentage of samples of EC (35.40%), compared to normal endometrium (4.76%), endometrial hyperplasia without atypia (2.08%) and in endometrial atypical hyperplasia (4.76%). There was more ALDH1 and CD44 expression in EC, compared to premalignant endometrial lesions. Importantly, a higher combine ALDH1 and CD44 score in cases of EC was correlated with poor overall survival, with a hazard ratio of 4.61 for death (95% confidence interval, 1.54–13.78).
Conclusions: Our results indicate that the prevalence of ALDH1high/CD44+ tumor cells in EC is significantly associated with worse prognostic factors and favors a poor prognosis. ALDH1 and CD44 expression is also a potential histopathology biomarker for the differential diagnosis of malignant and premalignant endometrial lesions.
Key words: Cancer stem cell, ALDH1, CD44, Endometrial carcinoma
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