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Updated: Jun 26, 2026
In vitro Enrichment of Ovarian Cancer Tumor-initiating Cells
Published on: February 18, 2015
The influence of CD117, CD133, CD24, CD44, and ALDH expression on progression-free survival in advanced-stage
Kade Yudi Saspriyana1, I Nyoman Gede Budiana2, Novi Silvia Hardiany3
1Doctoral Program in Medical Sciences Faculty of Medicine Universitas Indonesia/Gynecology Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Udayana University, Ngoerah Hospital, 80113 Bali, Indonesia.
Objective:
Cancer stem cell (CSC) markers are increasingly recognized as key indicators for tumour aggressiveness, chemoresistance, and recurrence in epithelial ovarian cancer (EOC). This study aimed to evaluate the expression of CSC markers, specifically CD117, CD133, CD24, CD44, and ALDH, individually and in combination, in relation to two-year progression-free survival (PFS) in patients with advanced-stage EOC.
Methods:
An ambispective cohort of 117 advanced-EOC patients was analysed. Recurrence was assessed according to the Response Evaluation Criteria in Solid Tumours criteria. CSC marker expression was measured by immunohistochemistry and categorised using H-score cut-offs derived from Receiver operating characteristic analysis. Associations with recurrence and PFS were assessed using Chi-square test, Kaplan-Meier analysis, and Cox regression.
Results:
Two-year recurrence occurred in 65.8% of patients, predominantly in stage III-IV. Individual CSC markers demonstrated poor discriminative ability (AUC<0.6), and most high-expression markers showed a trend toward shorter PFS and higher recurrence risk. Low CD133 expression was associated with longer PFS (12.0 vs 10.0 months; p=0.045). The combined five-marker panel and the CD133-ALDH signature were significant predictors of recurrence. Patients with low mean expression had longer PFS (17.94 vs 13.85 months, p=0.011; 17.0 vs 14.72 months, p=0.034). The SEM analysis revealed significant indirect interactions within CSC pathways that contributed to the risk of recurrence.
Conclusions:
Regardless of the limited independent prognostic value of individual CSC markers, their combined expression enhanced risk stratification for recurrence and survival in advanced EOC. Multimarker CSC profiling may enhance prognostication and aid in guiding personalized surveillance and therapeutic strategies.
