Novel Stem Cell Markers of Prime Prognostic Importance in Carcinoma Breast

Thamilselvi  Ramachandran; Anbu Lenin  Kulandhaivel; Lalitha Rani N; Devi Venkatesan; Prakash H Muddegowda

Thamilselvi Ramachandran Professor & Head, Department of Pathology, VMKVMC, Vinayaka Missions University, Salem, India.
Anbu Lenin Kulandhaivel Professor & Head, Department of Transfusion Medicine, VMKVMC, Vinayaka Missions University, Salem, India.
Lalitha Rani N Professor & Head, Department of Pathology, KAP Vishwanathan Government Medical College, Trichy, India.
Devi Venkatesan Assistant Professor, Department of Pathology, VMKVMC, Vinayaka Missions University, Salem, India.
Prakash H Muddegowda Associate Professor, Department of Pathology, Karwar Institute of Medical Sciences, Karwar, India.

Keywords: TNBC, CD24/ 44, Cancer Stem Cells, ER PR HER2/neu, Prognosis

Abstract

Introduction: The burden of breast cancer across the globe is rising and is anticipated to cross almost 2 million by 2030. Tumour markers estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)/neu along with cancer stem cells expression of CD24 and CD44 are crucial in predicting therapy resistance and prognosis.
Aim: This study was conducted to examine the expression of CD44/ CD24 and to compare and correlate the expression of ER, PR and HER2/neu with the expression of CD44/ 24, applied immunohistochemical markers on sectioned wax-embedded blocks of proven cases of carcinoma of the breast.
Materials and Method: The study spanned a duration of 3 years in a tertiary care centre and all histologically confirmed radical mastectomy cases were included. Immunohistochemical staining for ER, PR, HER2/neu, CD44 and CD24 was performed in formalin-fixed, paraffin wax-embedded tissue sections.
Results: Seventy participants were enrolled in the study based on inclusion and exclusion criteria. All cases involved females, averaging an age of 56.2 years. Histologically majority of participants were of infiltrating ductal carcinoma. Most cases were of Triple Negative Breast Cancer (TNBC) type (40%) followed by Luminal A type (30.9%). Among Infiltrating Ductal carcinoma, 27 were of CD44+/ CD24+ type and 17 were of CD44-/ CD24+ type.
Conclusion: Our study results indicate a correlation between the CD44+/ CD24- phenotype and molecular subtypes, with the highest expression noted in the HER2 subtype. We hereby emphasise that early detection and better management of these cases through a multimodality approach of markers could help in improved survival.

How to cite this article:
Ramachandran T, Kulandhaivel A L, Rani N L, Venkatesan D, Muddegowda P H. Novel Stem Cell Markers of Prime Prognostic Importance in Carcinoma Breast. Chettinad Health City Med J. 2024;13(4):121-127.

DOI: https://doi.org/10.24321/2278.2044.202468

References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021 May;71(3):209-49. [PubMed] [Google Scholar]

Mehrotra R, Yadav K. Breast cancer in India: present scenario and the challenges ahead. World J Clin Oncol. 2022 Mar 24;13(3):209-18. [PubMed] [Google Scholar]

DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA Cancer J Clin. 2011;61(6):409-18. [PubMed] [Google Scholar]

Jang MH, Kang HJ, Jang KS, Paik SS, Kim WS. Clinicopathological analysis of CD44 and CD24 expression in invasive breast cancer. Oncol Lett. 2016 Oct;12(4):2728-33. [PubMed] [Google Scholar]

Lindström LS, Karlsson E, Wilking UM, Johansson U, Hartman J, Lidbrink EK, Hatschek T, Skoog L, Bergh J. Clinically used breast cancer markers such as estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 are unstable throughout tumor progression. J Clin Oncol. 2012 Jul 20;30(21):2601-8. [PubMed] [Google Scholar]

Marzagalli M, Fontana F, Raimondi M, Limonta P. Cancer stem cells-key players in tumor relapse. Cancers (Basel). 2021 Jan 20;13(3):376. [PubMed] [Google Scholar]

Christiana JS, Balakrishnan K, Hemalatha G, Maheshwari KU. Clinical and histomorphological profile of breast neoplasms. Int J Sci Stud. 2016;4(4):170-5.

Sandhu GS, Erqou S, Patterson H, Mathew A. Prevalence of triple-negative breast cancer in India: systematic review and meta-analysis. J Glob Oncol. 2016 Jun 29;2(6):412-21. [PubMed] [Google Scholar]

Sarkar S, Akhtar M. Triple negative breast cancer prevalence in Indian patients over a decade: a systematic review. Int J Clin Biostat Biom. 2022;8:045. [Google Scholar]

Pandit P, Patil R, Palwe V, Gandhe S, Patil R, Nagarkar R. Prevalence of molecular subtypes of breast cancer: a single institutional experience of 2062 patients. Eur J Breast Health. 2019 Nov 20;16(1):39-43. [PubMed] [Google Scholar]

Sanmathi BS, Narayanan GS, Amogh PS, Kumar KB. Breast cancer in young women: analysis of incidence, clinicopathological profile and biological behaviour in a tertiary care institute from South India. Asian Pac J Cancer Biol [Internet]. 2024 [cited 2024 Dec 12];9(3):295-300. Available from: http://waocp.com/journal/index.php/apjcb/article/view/1446 [Google Scholar]

Stat bite: lifetime probability among females of dying of cancer. J Natl Cancer Inst. 2004 Jun 2;96(11):818. [PubMed]

Qing T, Karn T, Rozenblit M, Foldi J, Marczyk M, Shan NL, Blenman K, Holtrich U, Kalinsky K, Meric-Bernstam F, Pusztai L. Molecular differences between younger versus older ER-positive and HER2-negative breast cancers. NPJ Breast Cancer. 2022;8(1):119. [PubMed] [Google Scholar]

Siadati S, Sharbatdaran M, Nikbakhsh N, Ghaemian N. Correlation of ER, PR and HER-2/Neu with other prognostic factors in infiltrating ductal carcinoma of breast. Iran J Pathol. 2015 Summer;10(3):221-6. [PubMed] [Google Scholar]

Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9-29. [PubMed] [Google Scholar]

Ahmed MA, Aleskandarany MA, Rakha EA, Moustafa RZ, Benhasouna A, Nolan C, Green AR, Ilyas M, Ellis IO. A CD44-/CD24+ phenotype is a poor prognostic marker in early invasive breast cancer. Breast Cancer Res Treat. 2012;133(3):979-95. [PubMed] [Google Scholar]

Mylona E, Giannopoulou I, Fasomytakis E, Nomikos A, Magkou C, Bakarakos P, Nakopoulou L. The clinicopathologic and prognostic significance of CD44+/CD24-/low and CD44-/CD24+ tumor cells in invasive breast carcinomas. Hum Pathol. 2008;39(7):1096-102. [PubMed] [Google Scholar]

Horiguchi K, Toi M, Horiguchi SI, Sugimoto M, Naito Y, Hayashi Y, Ueno T, Ohno S, Funata N, Kuroi K, Tomita M, Eishi Y. Predictive value of CD24 and CD44 for neoadjuvant chemotherapy response and prognosis in primary breast cancer patients. J Med Dent Sci. 2010;57(2):165-75. [PubMed] [Google Scholar]

Bànkfalvi A, Terpe HJ, Breukelmann D, Bier B, Rempe D, Pschadka G, Krech R, Böcker W. Gains and losses of CD44 expression during breast carcinogenesis and tumour progression. Histopathology. 1998;33(2):107-16. [PubMed] [Google Scholar]

Baumann P, Cremers N, Kroese F, Orend G, Chiquet-Ehrismann R, Uede T, Yagita H, Sleeman JP. CD24 expression causes the acquisition of multiple cellular properties associated with tumor growth and metastasis. Cancer Res. 2005;65(23):10783-93. [PubMed] [Google Scholar]

Athanassiadou P, Grapsa D, Gonidi M, Athanassiadou AM, Tsipis A, Patsouris E. CD24 expression has a prognostic impact in breast carcinoma. Pathol Res Pract. 2009;205(8):524-33. [PubMed] [Google Scholar]

Honeth G, Bendahl PO, Ringnér M, Saal LH, Gruvberger-Saal SK, Lövgren K, Grabau D, Fernö M, Borg A, Hegardt C. The CD44+/CD24- phenotype is enriched in basal-like breast tumors. Breast Cancer Res. 2008;10(3):R53. [PubMed] [Google Scholar]

Wu Y, Sarkissyan M, Elshimali Y, Vadgama JV. Triple negative breast tumors in African-American and Hispanic/Latina women are high in CD44+, low in CD24+, and have loss of PTEN. PLoS One. 2013 Oct 22;8(10):e78259. [PubMed] [Google Scholar]