Jiang Peng, Tian Chenfan, Zheng Yunfeng, Gong Chunxia, Wang Jinyu, Liu Ying
Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Front Oncol. 2024 Apr 19;14:1338908. doi: 10.3389/fonc.2024.1338908. eCollection 2024.
The purpose of this study was to investigate the correlation between stemness markers (CD44 and CD133) and clinical pathological features, and to further explore the prognostic value of co-expression of CD44 & CD133 in endometrial cancer (EC).
Clinical data of stage I-III EC patients who underwent initial surgical treatment at two large tertiary medical centers from 2015 to 2020 were retrospectively collected. Cohen's kappa coefficient was used to show the consistency of the expression between CD44 and CD133. The correlation between co-expression of CD44 & CD133 and prognosis of EC patients was explored using univariate and multivariate Cox regression analysis. Then, the prognosis models for early-stage (stage I-II) EC patients were constructed. Finally, stratified analysis was performed for EC patients in high-intermediate-risk and high-risk groups, Kaplan-Meier analysis was used to compare the survival differences between patients with and without adjuvant therapy in different co-expression states (low expression, mixed expression, high expression) of CD44 & CD133.
A total of 1168 EC patients were included in this study. The consistency of the expression between CD44 and CD133 was 70.5%, the kappa coefficient was 0.384. High expression of CD44 & CD133 was associated with early FIGO stage (P=0.017), superficial myometrial invasion (P=0.017), and negative lymphatic vessel space invasion (P=0.017). Cox regression analysis showed that the co-expression of CD44 & CD133 was significantly correlated with the prognosis of early-stage (stage I-II) patients (P=0.001 for recurrence and P=0.005 for death). Based on this, the nomogram models were successfully constructed to predict the prognosis of early-stage EC patients. Meanwhile, Kaplan-Meier analysis showed that patients with adjuvant therapy had a better overall prognosis than those without adjuvant therapy in high-intermediate-risk and high-risk groups. However, there was no statistically significant difference in survival between patients with and without adjuvant therapy in high expression of CD44 & CD133 group (P=0.681 for recurrence, P=0.621 for death).
High expression of CD44 & CD133 was closely related to the adverse prognosis of early-stage EC patients. Meanwhile, patients with high expression of CD44 & CD133 may not be able to achieve significant survival benefits from adjuvant therapy.
本研究旨在探讨干性标志物（CD44和CD133）与临床病理特征之间的相关性，并进一步探讨CD44与CD133共表达在子宫内膜癌（EC）中的预后价值。
回顾性收集2015年至2020年在两家大型三级医疗中心接受初次手术治疗的I-III期EC患者的临床资料。采用Cohen's kappa系数来显示CD44和CD133表达之间的一致性。使用单因素和多因素Cox回归分析探讨CD44与CD133共表达与EC患者预后之间的相关性。然后，构建早期（I-II期）EC患者的预后模型。最后，对高中危组和高危组的EC患者进行分层分析，采用Kaplan-Meier分析比较CD44与CD133不同共表达状态（低表达、混合表达、高表达）下接受辅助治疗和未接受辅助治疗患者的生存差异。
本研究共纳入1168例EC患者。CD44和CD133表达之间的一致性为70.5%，kappa系数为0.384。CD44与CD133高表达与早期国际妇产科联盟（FIGO）分期（P=0.017）、浅肌层浸润（P=0.017）及阴性淋巴管间隙浸润（P=0.017）相关。Cox回归分析表明，CD44与CD133共表达与早期（I-II期）患者的预后显著相关（复发P=0.001，死亡P=0.005）。基于此，成功构建了列线图模型以预测早期EC患者的预后。同时，Kaplan-Meier分析表明，在高中危组和高危组中，接受辅助治疗的患者总体预后优于未接受辅助治疗的患者。然而，在CD44与CD133高表达组中，接受辅助治疗和未接受辅助治疗患者的生存无统计学显著差异（复发P=0.681，死亡P=0.621）。
CD44与CD133高表达与早期EC患者的不良预后密切相关。同时，CD44与CD133高表达的患者可能无法从辅助治疗中获得显著的生存益处。
