Expression of aldehyde dehydrogenase 1 (ALDH1) in endometrioid adenocarcinoma and its clinical implications

Aldehyde dehydrogenase 1 (ALDH1) is expressed in stem/progenitor cells, including cancer-initiating cells (CIC) of various organs. In the present study, ALDH1 expression was immunohistochemically examined in uterine endometrioid adenocarcinoma. The ALDH1 was expressed in a small portion of tumor cells, and these ALDH1-expressing cells were less mature than ALDH1-non-expressing cells. The ALDH1-expressing (ALDH1-hi) cells were more tumorigenic, resistant to anti-cancer agents and more invasive than ALDH1-lo cells. Culture of the sorted ALDH1-hi cells yielded both ALDH1-hi and ALDH1-lo cells, whereas ALDH1-lo cells yielded ALDH-lo cells alone. Clinically, a high-level of ALDH1 expression in tumor cells was correlated with T category, lymphatic invasion, recurrence and prognosis of patients. Patients with high ALDH1 expression showed poorer prognoses than those with low expression (P = 0.015 for disease-free survival [DFS] and P = 0.010 for overall survival [OS]), and high ALDH1 expression was an independent factor for poor prognosis. Aldehyde dehydrogenase 1 is a candidate for CIC marker for uterine endometrioid adenocarcinoma.