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Journal of Gastrointestinal Cancer
Springer Science+Business Media
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Abstract
Background Cancer stem cells proved to have a vital role in cell migration, invasion, metastasis, and treatment resistance of
colorectal cancer (CRC) that subsequently lead to poor clinical outcomes. These stem cells may be a novel therapeutic target for
the management of CRC progression. Signals of the Notch-1 pathway are responsible for acquisition of stem cell characters.
ALDH1 and CD44 are usually detected in stem cells in colorectal cancer.
Aim The aims of this work are to evaluate the immunohistochemical expression of cancer stem cell markers ALDH1, Notch1,
and CD44 in colorectal cancer and investigate their correlation with clinicopathological characters and patient survival.
Methods Paraffin-embedded specimens of 70 patients with primary colorectal carcinoma were analyzed for Notch 1, ALDH1,
and CD44 expressions by immunohistochemistry.
Results Notch1 was mainly located in the cytoplasm of CRC tissues, rarely expressed in adjacent normal tissues. A highly
statistically significant relationship was found between grading, lymphovascular invasion, the degree of lymphocytic infiltration,
peritumoral budding, lymph node ratio, lymph node metastasis, and Notch1 expression (p < 0.001). There was a highly statistically
significant relationship found between AJCC stage and Notch1 expression (p < 0.001). CD44 was mainly located in the
cell membrane of CRC tissues. A highly statistically significant relationship was found between grading (p = 0.006),
lymphovascular invasion, the degree of lymphocytic infiltration, peritumoral budding, lymph node metastasis, lymph node ratio,
and CD44 expression (p < 0.001). There was a highly statistically significant relationship found between AJCC stage and CD44
expression (p < 0.001). ALDH1 was detected in the cytoplasm of the CRC tissue. A highly statistically significant relationship
was found between grading, lymphovascular invasion, the degree of lymphocytic infiltration, peritumoral budding, lymph node
metastasis, lymph node ratio, and ALDH1 expression (p < 0.001). There was a highly statistically significant relationship found
between AJCC stage and ALDH1 expression (p < 0.001). There is a highly statistically significant direct correlation between
Notch1, CD44 expression, and ALDH1 expression (p < 0.001).
Conclusions There is a substantial correlation between Notch 1, ALDH1, and CD44 as cancer stem cell markers and lymph node
metastasis, advanced stage and tumor recurrence in colorectal carcinoma.
Conclusion Expression of stem cell markers ALDH1, Notch1, and CD44 correlates with poor prognosis in a CRC and represents
an independent prognostic factor. They are associated with a feature of epithelial-mesenchymal transition evidenced by their
association with high tumor burden.
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