Dr Sri Gowri M¹*, Parimala Sagar², Kavitha Prasad³, Dr Vanishree⁴ and Dr Prathibha Shridhar⁵, Dr Roopa Rao⁶

¹Consultant Oral and Maxillofacial Surgeon, India
²Reader, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India
³Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India
⁴Department of Oral Pathology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India
⁵Assistant Professor, Department of Oral And Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India
⁶Professor and HOD, Department of Oral Pathology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India

*Corresponding Author: Dr Sri Gowri M, Consultant Oral and Maxillofacial Surgeon, India. Email : drsrigowri10@gmail.com

Received: July 31, 2023; Published: December 28, 2023

Abstract

Aim: CD44 expression has been associated with aggressive behavior in cancers of different types. Although CD44 is a potential prognostic marker, it has not been adopted to wider clinical use in OSCC patients. The study aims at the assessment of the immunohistochemical expression of CD44 in Oral Squamous Cell Carcinoma (OSCC) and to correlate its expression with prognostic parameters.

Methodology: A total of 36 cases of OSCC, were included in the study which included well differentiated squamous cell carcinoma (WDSCC) and moderately differentiated. The sections were subjected to immunohistochemical study using CD44 antibody. The degree of intensity and distribution of CD44s immunostaining was assessed and correlated with prognostic markers such as tumor stage (tumor size), tumor grade (Broder’s histological grading), tumor site, nodal status, and survival.

Results: CD44 expression by tumor cells in OSCCs is statistically correlated with overall survival and tumor grade i.e. stronger intensity of CD44 immunoexpression was observed in WDSCC group, followed by MDSCC group. There was a correlation of CD44 with overall survival but no statistical significance observed with respect to the other prognostic markers.

Conclusion: Based on these observations it can be suggested that the decrease in expression of CD44 in OSCC cells may be due to the reduced cell‑to‑cell and cell‑to‑matrix adhesion, resulting in easy detachment from the rigid constitution. Low expression of CD44 in OSCC tissues may be an indicator of tumor invasion and high metastatic potential.

 Keywords: CD44; Oral Cancer; Squamous Cell Carcinoma; Immunohistochemistry

References

1. Athanassiou-Papaefthymiou M., et al. “Evaluation of CD44 variant expression in oral, head and neck squamous cell  carcinomas using a triple approach and its clinical significance”. International Journal  of Immunopathology and Pharmacology3 (2014): 337-349. 
2. Bánkfalvi A., et al. “Gains and losses of adhesion molecules (CD44, E‐cadherin, and β‐catenin)  during oral carcinogenesis and tumour progression”. The Journal of Pathology3 (2001): 343-351. 
3. Baschnagel AM., et al. “Combined CD44, c‐MET, and EGFR expression in  p16‐positive and p16‐negative head and neck squamous cell carcinomas”. Journal of  Oral Pathology and Medicine3(2017): 208-213. 
4. Chen J., et al. “Significance of CD44  expression in head and neck cancer: a systemic review and meta-analysis”. BMC  Cancer 14.1(2014):15. 
5. González-Moles MA., et al. “Adhesion molecule CD44 expression in non-tumour  epithelium adjacent to tongue cancer”. Oral Oncology3(2004): 281-286. 
6. Godge PY and Poonja LS. “Quantitative assessment of expression of cell  adhesion molecule (CD44) splice variants: CD44 standard (CD44s) and v5, v6  isoforms in oral leukoplakias: an immunohistochemical study”. Indian Journal of  Dental Research 22.3(2011): 493.
7. Hema KN., et al. “Immunohistochemical study of CD44s expression in oral squamous cell carcinoma-its  correlation with prognostic parameters”. Journal of Oral and Maxillofacial Pathology:  JOMFP, 18.2(2014): 162. 
8. Huang CF., et al. “Correlation of ALDH1,  CD44, OCT4 and SOX2 in tongue squamous cell carcinoma and their association with  disease progression and prognosis”. Journal of Oral Pathology and Medicine 43(7(2014): 492-498. 
9. Joshua B., et al. “Frequency of cells expressing CD44, a head and neck cancer stem cell  marker: correlation with tumor aggressiveness”. Head and Neck 34.1(2012): 42-49. 
10. Judd NP., et al. “ERK1/2 regulation of CD44  modulates oral cancer aggressiveness”. Cancer Research 72.1(2012): 365-374. 
11. Kawano T., et al. “Expression of E-cadherin, and CD44s and CD44v6 and its  association with prognosis in head and neck cancer”. Auris Nasus Larynx 31.1(2004): 35- 41. 
12. Kidwai F., et al. “The effects of CD44  down‐regulation on stem cell properties of head and neck cancer cell lines”. Journal  of Oral Pathology and Medicine 42.9(2013): 682-690. 
13. Kokko LL., et al. “Significance of site-specific prognosis of cancer stem cell marker  CD44 in head and neck squamous-cell carcinoma”. Oral Oncology 47.6(2011): 510-516. 
14. Kuo MYP., et al. “Expression of CD44s, CD44v5, CD44v6 and CD44v7‐8 in betel quid chewing‐associated oral premalignant lesions and squamous cell carcinomas in  Taiwan”. Journal of Oral Pathology and Medicine 27.9(1998): 428-433. 
15. Lee HJ., et al. “Positive expression of NANOG, mutant p53, and CD44 is directly  associated with clinicopathological features and poor prognosis of oral squamous  cell carcinoma”. BMC Oral Health, 15.1(2015): 153. 
16. Mărgăritescu C., et al. “The  utility of CD44, CD117 and CD133 in identification of cancer stem cells (CSC) in oral  squamous cell carcinomas (OSCC)”. Romanian Journal of Morphology and Embryology 52.3 (2011): 985-993. 
17. Monteiro LS., et al. “Prognostic significance of CD44v6,  p63, podoplanin and MMP‐9 in oral squamous cell carcinomas”. Oral Diseases 22.4(2016): 303-312. 
18. Oliveira LR., et al. “Cancer stem cell immunophenotypes in oral  squamous cell carcinoma”. Journal of Oral Pathology and Medicine 40.2(2011): 135-142. 
19. Perez A., et al. “CD44 interacts with EGFR and promotes head and  neck squamous cell carcinoma initiation and progression”. Oral Oncology 49.4(2013):306-313. 
20. Prffko J., et al. “Unaltered strong immunohistochemical expression of CD44‐v6 and‐v5  isoforms during development and progression of oral squamous cell  carcinomas”. Journal of Oral Pathology and Medicine 25.9(1996): 502-506. 
21. Sato S., et al. “Reduced expression of CD44 variant 9 is related to lymph node metastasis and poor survival in squamous cell carcinoma of tongue”. Oral  Oncology 36.6(2000): 545-549. 
22. Stoll C., et al. “Prognostic importance of the expression of CD44 splice variants in oral squamous  cell carcinomas”. Oral Oncology 35.5(1999): 484-489. 
23. Takamune Y., et al. “ADAM-17 associated with CD44 cleavage and metastasis in oral  squamous cell carcinoma”. Virchows Archiv 450.2(2007): 169-177. 
24. Wang SJ., et al. “Association of CD44 V3‐ containing isoforms with tumor cell growth, migration, matrix metalloproteinase  expression, and lymph node metastasis in head and neck cancer”. Head and Neck 29.6 (2007): 550-558. 
25. Wang SJ., et al. “Role of hyaluronan  synthase 2 to promote CD44‐dependent oral cavity squamous cell carcinoma  progression”. Head and Neck 35.4(2013): 511-520.

Citation

Citation: Dr Sri Gowri M., et al. “Expression of CD44 and its Clinicopathological Correlation in Oral Squamous Cell Carcinoma: An Immunohistochemical Study".Acta Scientific Otolaryngology 6.1 (2024): 05-13.

Copyright

Copyright: © 2024 Dr Sri Gowri M., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.