ANTI-CD44 EXPRESSION AS A PROGNOSTIC MARKER IN DIFFERENT STAGES OF TRIPLE-NEGATIVE BREAST CANCER PATIENTS AND ITS ASSOCIATION WITH CLINICOPATHOLOGICAL FACTORS

Abstract

Background: Cancer stem cells (CSC) within tumors play a central role in tumorigenesis. Therefore, identifying these cells is essential for developing more effective cancer therapy. Triple-Negative Breast Cancer (TNBC) is an aggressive subtype of breast cancer associated with poor prognosis. The role of CD44 detected by immunohistochemistry (IHC) as a potential CSC marker in breast carcinomas, particularly in the TNBC subtype, remains unclear and has shown inconsistent results. Study Aims: This study aims to evaluate CD44 expression among TNBC cases and to investigate the relationship between CD44 overexpression and tumor aggressiveness, based on clinicopathological factors, such tumor grade, metastasis, and tumor stage. The ultimate goal is to assess the potential of CD44 as a prognostic marker for TNBC. Methodology: This retrospective cross-sectional study included 100 TNBC cases diagnosed at King Hussein Cancer Center (KHCC) between 2018 and 2022, CD44 expression was evaluated using IHC and correlated with clinicopathological parameters. Tissue sections were subjected to immunohistochemical staining using antibody against the CD44 antigen marker. The proportion and intensity of CD44 immunostaining were assessed and correlated with prognostic markers obtained from patient’s records in the KHCC archive. Results: CD44 expression was observed in 73% of the total cases. A statistically significant association was found between positive CD44 expression and tumor grade (p= 0.024), tumor recurrence (p= 0.043), tumor size (p=0.037), and toward significant with distant metastasis (p=0.06). However, no significant associations were found between CD44 expression and other clinicopathological features including OS, and DFS. Conclusion: these findings suggest that while CD44 is closely associated with tumor aggressiveness, post-therapy recurrence, and shows a trend toward association with distant metastasis, it does not independently influence survival outcomes. Therefore, CD44 may serve as a potential biomarker of treatment response and tumor biology, but not necessarily as a standalone prognostic indicator for survival in TNBC.