title: CD44 expression indicates favorable prognosis in epithelial ovarian cancer.
abstract: OBJECTIVE
  The purpose of this study was to investigate the expression and prognostic significance of CD44 in epithelial ovarian cancer.
  
  
  METHODS
  We analyzed the expression of CD44 by immunohistochemistry in 307 epithelial ovarian cancers and evaluated its relation to hyaluronan, clinicopathological factors, and prognosis.
  
  
  RESULTS
  Fifty-one percent of the tumors had a high proportion of CD44-positive cells (i.e., >/==" BORDER="0">10%), and this high CD44 expression was significantly associated with cancer cell-associated hyaluronan, well-differentiated tumor, mucinous histological type, and early stage of the tumor. High CD44 expression predicted better 5-year overall survival (50% versus 22%) and recurrence-free survival (70% versus 34%) in the univariate analyses (P < 0.00005 for both). In the Cox multivariate analyses, the independent predictors of overall survival at 5 years were primary residual tumor (P < 0.0005), International Federation of Gynecologists and Obstetricians (FIGO) stage (P = 0.001), histological grade (P = 0.014), adjuvant chemotherapy (P = 0.004), and stromal hyaluronan level (P < 0.0005), but not CD44. However, the expression of CD44 (P = 0.04) and stromal hyaluronan (P = 0.005) were both independent predictors of recurrence-free survival at 5 years, together with the size of the primary residual tumor (P < 0.0005) and histological type (P = 0.043).
  
  
  CONCLUSIONS
  The relatively frequent ectopic expression of CD44 on ovarian cancer cells is thus related to well-differentiated, early-stage tumor and long survival of the patients. Thus, whereas CD44-expressing cancer cells may adhere and implant to the hyaluronan-positive mesothelium, at least in model systems, high expression of CD44 in the tumor does not bring about an unfavorable prognosis.
authors: Department of Pathology and Forensic Medicine, University of Kuopio and Kuopio University Hospital, Finland.
authors: Sari
authors: S
authors: Sillanpää
authors: Maarit A
authors: MA
authors: Anttila
authors: Kirsi
authors: K
authors: Voutilainen
authors: Raija H
authors: RH
authors: Tammi
authors: Markku I
authors: MI
authors: Tammi
authors: Seppo V
authors: SV
authors: Saarikoski
authors: Veli-Matti
authors: VM
authors: Kosma
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D014408:Biomarkers, Tumor / Q000378:metabolism; D018269:Carcinoma, Endometrioid / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D002454:Cell Differentiation; D017024:Chemotherapy, Adjuvant; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D004848:Epithelium / Q000378:metabolism; D005260:Female; D005387:Finland; D006801:Humans; D018960:Hyaluronan Receptors / Q000378:metabolism*; D006820:Hyaluronic Acid / Q000378:metabolism*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D011379:Prognosis; D017154:Stromal Cells / Q000378:metabolism; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D018960:Hyaluronan Receptors; D006820:Hyaluronic Acid