Expression of CD133 is associated with poor prognosis in stage II colorectal carcinoma

Abstract

CD133 is currently believed to be one of the best colorectal cancer stem cell markers. This study aimed to evaluate prognostic significance of CD133 expression in colorectal cancer patients.A total of 303 patients with stage I to III colorectal cancer who underwent curative surgical resection from 2003 to 2008 at a single institution were included. CD133 expression was evaluated using immunohistochemical staining, and clinicopathological data were retrospectively reviewed. The patients were dichotomized after scoring CD133 expression (0 to 2+: low CD133 expression vs 3+ to 4+: high CD133 expression) according to the extent of area of CD133 positive tumor cells (<50% vs ≥50%) and pattern of staining (membranous staining of the luminal surface and/or staining of cellular debris in the tumor glands and cytoplasm).The 5-year overall survival (OS) (61.9% vs 80.2%, P = .001) and disease-free survival (64.8% vs 75.8%, P = .026) were poorer in the high CD133 expression group than the low CD133 expression group. In the multivariate analysis for risk factors of OS in the whole population, higher nodal stage (N2 compared to N0: hazard ratio [HR] 3.141; 95% confidence interval [CI] 1.718-5.744, P < .001), perineural invasion (HR 2.262; 95% CI 1.347-3.798, P = .002) and high CD133 expression (HR 1.929; 95% CI 1.221-3.048, P = .005) were independent poor prognostic factors of OS. Subgroup analyses according to each TNM stage revealed that CD133 expression was associated with OS only within the stage II patients (HR 3.167 95% CI 1.221-8.216, P = .018). Furthermore, the stage II patients demonstrating the high CD133 expression showed survival benefit of adjuvant chemotherapy, regardless of high-risk feature positivity (HR 0.201 95% CI 0.054-0.750, P = .017).High CD133 expression is correlated with poor prognosis in colorectal cancer patients after radical resection. The CD133 expression may serve as a more potent and informative biomarker for prognosis than conventional high-risk features in the stage II colorectal cancer patients.

Figure 1

CD133 scoring in CRC specimens at 20 × 10 magnification. (A) Nontumor tissue was negative for CD133 expression. (B) Tumor tissue displayed no staining. (C) Only luminal staining <50%. (D) Luminal and cytoplasmic staining <50%. (E) Only luminal staining ≥50%. (F) Luminal and cytoplasmic staining ≥50%. CRC = colorectal cancer.

Figure 2

Kaplan–Meier curves for overall survival and disease-free survival in the whole population. (A) The high CD133 expression group displayed significantly lower overall survival. (B) The high CD133 expression group displayed significantly lower disease-free survival.

Figure 3

Kaplan–Meier curves for overall survival in each stage. (A) No significant difference in survival was shown in stage I patients. (B) The high CD133 expression group displayed significantly lower overall survival in stage II patients. (C) No significant difference in survival was shown in stage III patients.