# Association Between Cancer Stem Cell Marker Expression and Clinicopathological Features in Thai Patients With Hepatocellular Carcinoma

## TL;DR

This study examined cancer stem cell markers in Thai patients with liver cancer and found higher marker levels in tumors, but no clear link to patient outcomes.

## Contribution

The study provides insights into CSC marker expression in a Thai HCC cohort, highlighting their potential role in tumor biology.

## Key findings

- All four CSC markers were significantly overexpressed in tumor tissues compared to noncancerous tissues.
- No significant associations were found between marker expression and clinicopathological parameters.
- Low CD44 and CD133 expression was associated with a trend toward better survival, though not statistically significant.

## Abstract

Introduction

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. Cancer stem cells (CSCs) are believed to play critical roles in tumor initiation, progression, metastasis, and treatment resistance. This study aimed to evaluate the expression of the four most commonly CSCs with relevant to HCC, namely, CD44, CD90, CD133, and epithelial cell adhesion molecule (EpCAM), in tumor and adjacent noncancerous tissues of Thai HCC patients and to explore their association with clinicopathological features and patient survival.

Methods

HCC patients undergoing curative hepatic resection at the National Cancer Institute, Thailand, were included. Tumor and matched adjacent noncancerous tissues were collected and analyzed for the expression of CD44, CD90, CD133, and EpCAM using immunohistochemistry (IHC). IHC scores were calculated based on staining intensity and extent. Associations between marker expression and clinicopathological features were assessed, and overall survival was analyzed using the Kaplan-Meier method.

Results

All four CSC markers were significantly overexpressed in tumor tissues compared to adjacent normal tissues (P < 0.05). However, no statistically significant associations were found between marker expression and clinicopathological parameters. Kaplan-Meier analysis showed no significant differences in overall survival between high and low expression groups. Nonetheless, patients with low CD44 and CD133 expression tended to have better survival outcomes, although not statistically significant.

Conclusion

The findings suggest that CD44, CD90, CD133, and EpCAM were enriched in HCC tumor tissues, supporting their role in hepatocarcinogenesis. However, no strong correlations were found with clinical features or survival in this cohort.