title: CD44 variant 9 expression in primary early gastric cancer as a predictive marker for recurrence.
abstract: BACKGROUND
  Multiple early gastric cancers (EGCs) may develop in 6-14% of patients even after achieving curative endoscopic submucosal dissection (ESD); however, a useful biomarker for predicting recurrence is not available. The present study investigated whether the expression of CD44 variant 9 (CD44v9), a functional cancer stem cell marker, in the primary gastric cancer tissue represents an indicator of recurrence.
  
  
  METHODS
  Eighty-eight patients who underwent ESD for EGC from 2008 to 2010 were enrolled and monitored for recurrence for 3 years. The expression levels of CD44v9 in the tissue of initial EGCs were evaluated by immunohistochemistry, and the recurrence rate was compared between CD44v9-positive and CD44v9-negative groups. The mucin phenotype and expression of microRNA-21 (miR-21) and programmed cell death protein 4 (PDCD4) were also analysed.
  
  
  RESULTS
  The recurrence rate of EGC was significantly higher in the CD44v9-positive group than in the CD44v9-negative group (hazard ratio (HR), 21.8; 95% confidence interval (CI), 5.71-83.1). However, mucin phenotypes and the expression of miR-21 and PDCD4 did not predict recurrence after ESD. Meanwhile, grade of gastric atrophy was also identified as a significant marker of multiple recurrence (HR, 4.95; 95% CI, 1.30-18.8).
  
  
  CONCLUSIONS
  CD44 variant 9 expression represents a potential predictive marker for recurrence in EGC.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hirata
authors.forename: H
authors.initials: H
authors.lastname: Suzuki
authors.forename: H
authors.initials: H
authors.lastname: Imaeda
authors.forename: J
authors.initials: J
authors.lastname: Matsuzaki
authors.forename: H
authors.initials: H
authors.lastname: Tsugawa
authors.forename: O
authors.initials: O
authors.lastname: Nagano
authors.forename: K
authors.initials: K
authors.lastname: Asakura
authors.forename: H
authors.initials: H
authors.lastname: Saya
authors.forename: T
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D018450:Disease Progression; D004724:Endoscopy; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D018960:Hyaluronan Receptors / Q000378:metabolism / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; C448906:CD44v9 antigen; D018960:Hyaluronan Receptors