Impact of SOX2 and CD44 as Cancer Stem Cell Markers in Urinary Bladder Carcinoma: Thesis Abstract

Abstract

Background: In Egypt, bladder cancer (BC) is the third common malignant tumor. The most important items of CSCs regulatory core are transcription factors like SOX2. The cell adhesion molecule CD44 has also been found as a cell surface marker with CSCs in multiple types of tumors, like BC. Aim: This study was conducted to detect the expression of SOX2 and CD44 and correlate their expression with the available pathological parameters. Materials and Methods: The study was done on 80 cases of BC (60 cases of transitional cell carcinoma, 17 cases of squamous cell carcinoma and three cases of adenocarcinoma), 20 specimens were collected by radical cystectomy and 60 specimens were collected by transurethral resection. The specimens were immunostained with SOX2 and CD44. Results: SOX2 was positive in 46 cases of urothelial carcinoma (76.7%), 11 cases of SCC (64.7%) and all adenocarcinoma cases. SOX2 immunostaining was significantly increased with muscular invasion, and high stage in urinary bladder carcinomas. CD44 was positive in 46/60 cases of urothelial carcinoma (76.7%) and all cases of squamous cell carcinoma. The basal cell layer of adjacent, apparently normal urothelium, was also expressed a positive reaction for CD44. There was significant inverse relation in statistics between CD44 and tumor grade. CD44 was also inversely correlated with muscle invasion. Conclusion: SOX2 overexpression could be used as a marker of poor progression in bladder carcinoma cases. It could be a target for an efficient therapeutic strategy of BC treatment, high grades and more liability for infiltration. BC is associated with low expression or complete loss of CD44 immune reactivity.

Prognostic Implications of CD24, SOX2, and Nanog Expression in Invasive Urothelial Carcinoma

“…In the current study, we found a significant association between SOX2 expression and stage P =0.01 which was in line with the results of previous IHC studies as those made by Fekry et al, 37 Bao et al, 36 and Amer and Amer 35 …”

“…We found a significant association between SOX2 expression and high grade (P ≤ 0.001), this is in agreement with the study made by Bao et al, 36 Fekry et al, 37 and Gayyed et al 38 who found a significant association between SOX2 expression and grade, but in contrary to what reported by Amer and Amer 35 who failed to find significant correlation between SOX2 expression and tumor grade (P = 0.267), also in the study made by Bayoumi et al, 39 who did not find any significant relation between SOX2 expression and tumor grade.…”

“…In our study, we found that SOX2 was expressed in 60 of 80 patients (75%). This is near to the result of Amer and Amer 35 who found SOX2 expressed in 76.7% of patients. But in the study by Bao et al, 36 it was expressed only in 24% of studied cases, also in the study by Fekry et al, 37 SOX2 was highly expressed in 43.3% of studied cases.…”

“…Many studies established that SOX2 fosters bladder carcinogenesis by induction of the IGF2/IGF1R pathway; pharmacological suppression of this pathway inhibits BC cell survival. 35 In our study, expression of Nanog is significantly associated with high tumor stage, grade, LVI, disease-free survival, and overall survival. Results are in concordance with previous data obtained by Akhir et al 21 who found that expression of Nanog in their study increased with tumor stage and grade.…”

“…40 In the current study, we found a significant association between SOX2 expression and stage P = 0.01 which was in line with the results of previous IHC studies as those made by Fekry et al, 37 Bao et al, 36 and Amer and Amer. 35 However, Bayoumi et al 39 found no significant association between SOX2 expression and tumor stage; however, in gastric cancer and squamous cell lung cancer, SOX2 has been reported to be associated with improved outcomes as in the study made by Zhang et al 41 and Wilbertz et al 42 Also in this study, we found a significant association between SOX2 expression and, LVI, LN (P = 0.003, 0.036), respectively, this agrees with a study made by Fekry et al 37 who found a significant association between SOX2 expression and LN metastasis.…”