Clinicopathological and prognostic relevance of nestin in low- and high-grade gliomas: An immunohistochemical study

doi:10.5306/wjco.v17.i5.118350

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Oncol. May 24, 2026; 17(5): 118350
Published online May 24, 2026. doi: 10.5306/wjco.v17.i5.118350

Clinicopathological and prognostic relevance of nestin in low- and high-grade gliomas: An immunohistochemical study

Sabeen Nasir, Asif Ali, Ihsan Ullah, Shabnam Wazir, Irum Javaid, Summaya Z Jalal, Ishaq Khan, Muhammed Mubarak

Sabeen Nasir, Department of Pathology, Jinnah Medical College, Khyber Medical University, Peshawar 24840, Khyber Pakhtunkhwa, Pakistan

Asif Ali, Department of Histopathology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan

Asif Ali, Department of Pathology, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia

Ihsan Ullah, Department of Pathology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 24840, Khyber Pakhtunkhwa, Pakistan

Shabnam Wazir, Department of Anatomy, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 24840, Khyber Pakhtunkhwa, Pakistan

Irum Javaid, Department of Anatomy, North West School of Medicine, Peshawar 24840, Khyber Pakhtunkhwa, Pakistan

Summaya Z Jalal, Department of Anatomy, Jinnah Medical College, Khyber Medical University, Peshawar 24840, Khyber Pakhtunkhwa, Pakistan

Ishaq Khan, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 24840, Khyber Pakhtunkhwa, Pakistan

Muhammed Mubarak, Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan

Author contributions: Ali A and Nasir S contributed to conceptualization; Ullah I and Nasir S contributed to data curation; Javaid I and Nasir S contributed to formal analysis; Wazir S and Nasir S contributed to experimentation; Nasir S contributed to methodology and primary drafting; Ali A and Khan I contributed to supervision and validation; Ali A, Jalal SZ, and Mubarak M contributed to critical review for intellectual content and final drafting.

Institutional review board statement: The study was reviewed and approved by the Khyber Medical University, Pakistan, No. KMU/IPMD/IEC/2022/08.

Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The dataset and related documents are available from the lead author.

Corresponding author: Muhammed Mubarak, Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. drmubaraksiut@yahoo.com

Received: December 30, 2025
Revised: January 10, 2026
Accepted: March 9, 2026
Published online: May 24, 2026
Processing time: 141 Days and 20.1 Hours

Abstract

BACKGROUND

Gliomas, the most prevalent primary malignant brain tumours, display remarkable heterogeneity in behaviour and prognosis. Mounting evidence implicates cancer stem cells and their associated markers in gliomagenesis and treatment resistance. Nestin, a class VI intermediate filament protein linked to neural stemness and cytoskeletal remodelling, has emerged as a potential prognostic biomarker.

AIM

To evaluate the association of nestin expression, tumour grade, and survival in glioma patients from Pakistan.

METHODS

This prospective cohort study included 128 histologically confirmed glioma cases (64 low-grade; 64 high-grade) diagnosed at Prime Teaching Hospital, a tertiary care teaching hospital in Khyber Pakhtunkhwa, Pakistan, between January 2023 and September 2024. Nestin expression was evaluated by immunohistochemistry using the Immunoreactive Score system and categorized as high or low expression. Associations were assessed using Fisher’s exact test or χ² test, and survival outcomes were analyzed using the Kaplan-Meier method.

RESULTS

High-grade tumours exhibited higher nestin overexpression rates compared to low-grade gliomas (90.6% vs 70.3%, P = 0.004), and the median overall survival was 3 months for high-grade tumours and 26 months for low-grade tumours. In patients with high nestin expression, shorter survival (8 months) was seen, while those with low expression showed longer survival (22 months, P = 0.025). When analysed in combination, a trend towards the poorest prognosis in high-grade gliomas with high nestin (median 2 months) and the best in low-grade with low nestin (26 months, P = 0.001) was observed. No significant association was observed with patients’ gender, age, or tumour site.

CONCLUSION

Nestin overexpression is associated with higher glioma grade and poorer overall survival across astrocytic and oligodendroglial tumors and may serve as a supplementary prognostic biomarker, particularly in settings with limited access to molecular diagnostics.

Keywords: Low-grade glioma; High-grade glioma; Cytoskeletal protein nestin; Survival analysis; Tumour grade

Core Tip: Gliomas show marked biological heterogeneity, necessitating accessible prognostic biomarkers, especially in resource-limited settings. This prospective study demonstrates that nestin overexpression is significantly associated with higher tumour grade and inferior overall survival in both low- and high-grade gliomas. High-grade tumours showed markedly increased nestin expression and substantially shorter survival compared to low-grade counterparts. Patients with high nestin expression experienced poorer outcomes, while the combined analysis revealed the worst prognosis in high-grade gliomas with high nestin levels. These findings highlight nestin as a practical supplementary prognostic marker that may aid risk stratification where advanced molecular testing is unavailable.