Clinical implications of CD44+/CD24- tumor cell ratio in breast cancer.
OBJECTIVE
To investigate the association of the CD44+/CD24- cancer stem cell (CSC) ratio with clinicopathologic features and its prognostic value in breast cancer.


METHODS
The CD44+/CD24- CSC ratio was determined in formalin-fixed, paraffin-embedded breast cancer tissues from 1350 breast cancer patients by double immunofluorescence staining. The Cox regression analysis was performed to evaluate whether the CD44+/CD24- CSC ratio is an independent prognostic factor. The Kaplan-Meier survival analysis was conducted to determine the association of the CD44+/CD24- CSC ratio with cancer-specific survival.


RESULTS
The mean average CSC ratio in clinical specimens was 8.06% (range from 1.02% to 37.54%). The CD44+/CD24- CSC ratio, together with histological grade, molecular type, and clinical stage, was independent prognostic factors of breast cancer. The CD44+/CD24- CSC ratio was significantly correlated with estrogen receptor (ER), progesterone receptor (PR), and Ki67, but not the Her-2 and P53 status. Furthermore, the CD44+/CD24- CSC ratio was significantly associated with 5-year breast cancer-specific survival in 1242 cases (88.97% vs. 75.76% vs.52.11% for ≤ 5%, 5%-10% and >10% CSC ratio cases, respectively, p=0.001). The linear regression analysis showed that the CSC ratio was borderlinely correlated with the N stage related (R=0.397 p=0.06), and significantly correlated with distant recurrence (R=0.487, p=0.01) in 1350 specimens. After the survival analysis, the 5-year distant recurrence rates were (57/435 [13.10%] vs. 159/594 [26.77%] vs. 114/213 [53.52%] for ≤ 5%, 5%-10%, and >10% CSC ratio cases, p=0.001).


CONCLUSIONS
The CSC ratio was an independent prognostic factor for breast cancer as well as a potential predictive marker for chemotherapy in breast cancer.
Department of General Surgery, The First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning Province, China.
Caigang
C
Liu
Yang
Y
Luo
Xing
X
Liu
Ping
P
Lu
Zuowei
Z
Zhao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis / Q000276:immunology; D001943:Breast Neoplasms / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D051927:CD24 Antigen / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006801:Humans; D018960:Hyaluronan Receptors / Q000032:analysis / Q000378:metabolism*; D007150:Immunohistochemistry; D008875:Middle Aged; D014411:Neoplastic Stem Cells / Q000276:immunology* / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis
D014408:Biomarkers, Tumor; D051927:CD24 Antigen; D018960:Hyaluronan Receptors