Correlation of prognosis of oral squamous cell carcinoma with CD44 expression: A retrospective immunohistochemical analysis

Abstract

ABSTRACT Background: Cluster of differentiation (CD44) is a cancer stem cell marker responsible for angiogenesis, invasion, and migration in oral squamous cell carcinoma (OSCC). Objectives: The primary objective of the study was to analyze the difference in expression of CD44 among different grades of OSCC. The secondary objective was to correlate the prognosis with the expression. Materials and Methods: Based on histopathological diagnosis, we retrieved OSCC paraffin-embedded blocks from the archives of the Department of Oral Pathology, Sri Ramaswamy Memorial (SRM) Dental College, Chennai, India, reported from January 2012 to May 2022. We evaluated sections from 15 tissues of normal oral mucosa, 15 paraffin blocks of well-differentiated OSCC, 15 moderately differentiated OSCC, and 15 poorly differentiated OSCC for CD44 immunostaining. Immunohistochemical expression of CD44 was studied in these tissues and graded based on the intensity of staining. The difference in immune expression of CD44 between different grades was quantitatively analyzed using image analysis by Fiji image analysis software. Analysis of variance (ANOVA) was used to compare the mean difference in expression between different groups by using the Statistical Package for Social Sciences (SPSS) software version 16. Statistical significance was set at P < 0.05. Results: We identified that 10% (n = 6) of the normal mucosa showed strong expression of CD44, whereas 13.3% (n = 8) of well-differentiated OSCC, 10% (n = 6) of moderately differentiated OSCC, and 0% (n = 0) of poorly-differentiated OSCC were strongly positive for CD44 expression. The difference in comparison was statistically significant (P, 0.003). By quantitative analysis, the mean expression of CD44-positive cells in well-differentiated OSCC was 38258 ± 4762, moderately-differentiated OSCC was 27353 ± 1357, and poorly-differentiated OSCC was 10265 ± 1685. Upon comparison, the difference in mean was found to be significant (P, 0.002). Conclusion: The expression of CD44 was noted to decrease from well-differentiated to poorly-differentiated OSCC.