Cd44s and Cd44v6 Expression is Associated with Improved Survival in Malignant Fibrous Histiocytoma

Abstract

The value of new prognostic markers are currently being investigated as potential adjuvant and/or palliative treatment options in the management of soft tissue sarcomas (STS). Several recent studies have shown that CD44 expression is associated with a better outcome in select cancers as bladder tumors. The aim of this study was to evaluate the expression of CD44 in STS of the adult and to determine whether CD44 expression correlates with the clinical outcome. We examined the clinical outcome of 34 adult MFH patients (19 men and 15 women, average age 62 years, median 63 years, ranged from 38 to 88 years) who underwent curative treatment for STS. The majority of patients received adjuvant radiotherapy (n = 25). No patient received initial adjuvant chemotherapy. The expressions of CD44, CD44 isoforms and the reference genes beta-actin and beta-microglobulin were analyzed by quantitative real-time PCR. For relative quantification and to normalize the amount of the CD44 product and the CD44 isoform products, the delta-CT method using the expression of the reference genes beta-actin or beta-microglobulin was used. High CD44s expression levels were positively correlated with a lower tumor-related death (p < 0.05, log-rank test 3.85). Conversely, high expression levels of hCD44 were negatively correlated with a tumor-related death and with a median survival of 43 months as compared to 61 months in patients with low expression levels. In the three analyzed variants of CD44, high expression levels of CD44v6 and CD44v8 correlated negatively with the tumor-related survival. Multivariate prognostic risk factors based on the Cox proportional-hazards regression model included three variables: CD44s (p = 0.006), CD44v6 (p = 0.003) as well as resection quality (p = 0.03) and were all identified as significant parameters of survival. Low expression levels of CD44s as well as high expression levels of CD44v6 and CD44v8 correlate with poor outcome.