title: Prognostic value of CD44 expression in penile squamous cell carcinoma: a pilot study.
abstract: BACKGROUND
  Several studies have reported on the prognostic value of molecular markers for metastasis risk and survival in penile squamous cell carcinoma (SCC) patients. The usefulness of CD44 expression as such a marker has been studied in different tumors, but not in penile SCC. Our aim was to determine whether CD44 expression may serve as a prognostic marker for lymph node metastasis and survival in penile SCC patients.
  
  
  METHODS
  CD44 immunoistochemical expression was investigated in tissue specimens from 39 patients with penile SCC. CD44 cell positivity, staining intensity and distribution were analyzed and correlated with tumor stage, grade, lymph node status and disease-specific survival.
  
  
  RESULTS
  CD44 expression was detected in epithelial cells of both intratumoral and normal tissues with different intensities and staining distributions. In normal tissues CD44 protein was mainly detected in cell membranes, whereas in the tumor compartments it was found in both the cell membranes and the cytoplasm. The intensities and percentages of CD44 expressing cells did not correlate with tumor stage and/or grade. Seventy-three percent of the patients with lymph node metastasis showed high intensities of CD44 staining, as compared to 44% of the patients without lymph node metastasis (P = 0.03). Lymph node-positive patients showed both cytoplasmic and membranous CD44 expression. High CD44 expression was found to be significantly correlated with a decreased 5 year overall survival (P = 0.01).
  
  
  CONCLUSIONS
  CD44 levels and patterns of expression can be considered as markers for penile SCC aggressiveness and, in addition, may serve as predictive markers for lymph node metastasis, also in patients with clinically negative lymph nodes. CD44 expression may provide prognostic information for penile SCC patients, next to classical clinical-pathological factors.
authors.affiliation: Institute of Maternal and Children's Sciences, Urology, Polytechnic University of the Marches Region, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. d.minardi@univpm.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Minardi
authors.forename: Guendalina
authors.initials: G
authors.lastname: Lucarini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Filosa
authors.forename: Antonio
authors.initials: A
authors.lastname: Zizzi
authors.forename: Oriana
authors.initials: O
authors.lastname: Simonetti
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Offidani
authors.forename: Gianluca
authors.initials: G
authors.lastname: d'Anzeo
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Primio
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muzzonigro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000378:metabolism* / Q000473:pathology*; D018572:Disease-Free Survival; D004847:Epithelial Cells / Q000378:metabolism / Q000473:pathology; D006801:Humans; D018960:Hyaluronan Receptors / Q000378:metabolism*; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000378:metabolism* / Q000473:pathology*; D010865:Pilot Projects; D011379:Prognosis; D013194:Staining and Labeling; D016019:Survival Analysis
chemical_list: C497483:CD44 protein, human; D018960:Hyaluronan Receptors