Co-expression of cancer stem cell markers CD24 and CD133 in gastric cancer tissues: Clinicopathological and prognostic significance

Abstract

BACKGROUND

Gastric cancer (GC) is one of the most common malignant tumors of the digestive system worldwide, the prognosis of patients with advanced GC remains poor.

AIM

To evaluate the combined expression characteristics of cancer stem cell markers CD24 and CD133 in GC pathological tissues, and to explore their association with patients’ clinicopathological parameters and postoperative survival outcomes.

METHODS

A total of 304 GC patients who underwent surgical treatment in our hospital from January 2018 to January 2020 were retrospectively included. Immunohistochemistry was used to detect the protein expression of CD24 and CD133 in tumor tissues, adjacent tissues, and normal gastric mucosa tissues. Based on staining intensity and the proportion of positive cells, expression levels were classified into low and high expression, while clinicopathological parameters were recorded. χ² test was used to evaluate the correlation between expression and categorical variables, Spearman rank correlation analysis was performed to assess the correlation between the expression intensities of the two markers, and multivariate regression models were applied to identify independent risk factors influencing co-expression. Kaplan-Meier survival curves and Log-rank test were used to compare survival differences among groups with different expression patterns.

RESULTS

Among the 304 patients, 155 cases (50.99%) were CD24 positive, including 91 low-expression and 64 high-expression; 133 cases (43.75%) were CD133 positive, including 81 low-expression and 52 high-expression. There were 74 cases (24.34%) with double positivity and 81 cases (26.64%) with double negativity. Compared with tumor tissues, the positive rates of CD24 and CD133 in normal gastric tissues and adjacent tissues were significantly lower (P < 0.05). Univariate analysis showed that co-expression of CD24 and CD133 in GC tissues was significantly correlated with tumor size, Lauren classification, T stage, N stage, and vascular invasion (P < 0.05), but not with patient age, gender, tumor site, World Health Organization histological classification, or M stage (P > 0.05). Further multivariate regression analysis suggested that tumor size, T stage, N stage, and vascular invasion were independent risk factors promoting CD24 and CD133 double positivity. Spearman rank correlation analysis indicated a moderate positive correlation between their expression intensities (r = 0.420, P < 0.001). During follow-up, 29 of 304 patients were lost (loss rate 9.54%); 146 deaths occurred. According to expression combination, there were 89 cases of CD24 single positivity (39 deaths), 68 cases of CD133 single positivity (31 deaths), 81 cases of double negativity (25 deaths), and 66 cases of double positivity (51 deaths). Log-rank test showed significant differences in overall survival among the four groups (χ² = 20.89, P < 0.001), with CD24+/CD133+ group showing the worst prognosis.

CONCLUSION

CD24 and CD133 exhibit high positive detection rates in GC tissues, and their co-positivity is closely associated with tumor stage progression and significantly indicates unfavorable survival outcomes. The co-expression of CD24/CD133 may reflect higher aggressiveness and metastatic potential of GC, serving as a potential prognostic marker and a direction for targeted therapeutic strategies. However, as this is a single-center retrospective study with limitations such as patient loss to follow-up and sample size, further prospective, multicenter, and mechanistic studies are required to validate its clinical applicability and biological role.

Keywords: Gastric cancer; CD24; CD133; Cancer stem cell; Co-expression; Prognosis; Immunohistochemistry

Core Tip: CD24 and CD133 exhibit high positive detection rates in gastric cancer tissues. The co-expression of CD24 and CD133 was closely related to the advanced tumor stage. Co-positivity of CD24 and CD133 predicts poor survival. The co-expression of CD24/CD133 may reflect the higher invasive and metastatic potential of gastric cancer. This combined indicator can be used as a potential prognostic marker and direction for targeted therapeutic strategies.