An Immunohistochemical Study of Breast Cancer Brain Metastases: The Role of CD44 and AKT in the Prognosis

Abstract

Breast cancer is a major health burden, and up to one-third of patients with breast cancer develop brain metastases, which are linked to a very poor prognosis. Few biomarkers are available to predict the prognosis of patients with metastases. Assessment by immunohistochemistry may be used as a tool to predict the behavior of these tumors. A retrospective transversal study including 114 patients (diagnosed between 2000 and 2016) with breast cancer brain metastases was carried out using archival biological material from 114 patients with breast cancer brain metastases. Expression of CD44, HER2, ER, PR, CA9, PDL-1, CD133, ALDH1, PTEN, AKT, PI3K, and AR markers was assessed by immunohistochemistry. The overexpression of CD44 and AKT was associated with worse overall survival (P=0.047 and P=0,034, respectively), on univariate analysis, in the cohort of parenchymal and bone metastases; the impact of AKT expression was also evident in the parenchymal cohort on uni (P=0.021) and multivariate analysis (P=0.027). The remaining markers did not exhibit a statistical correlation. Immunohistochemistry markers such as CD44 and AKT may have a prognostic impact on survival in patients with breast cancer brain metastases. The conjugation with other markers may help with the stratification of patients and therapy.

CD44 and its implication in neoplastic diseases

“…Moreover, in lung adenocarcinoma, GPR124‐enhanced trans‐endothelial migration mediated brain metastases caused by lung CSCs with high expression of CD44 46 . Furthermore, in breast cancer brain metastases patients, a retrospective transversal study revealed that CD44 was associated with worse overall survival 47 . In general, CD44 is a promising marker associated with brain metastases in cancer patients, which provides us with the new insight into stratification of patients and therapy clinically.…”