Unedo Hence Markus Sihombing1,2,3, Andrijono Andrijono4, Gatot Purwoto4, Supriadi Gandamihardja5, Alida R Harahap6,7, Primariadewi Rustamadji8, Aria Kekalih9, Retno Widyawati8,10, Dzicky Rifqi Fuady11,12. 1. Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, Tarakan Hospital, Jakarta, Indonesia. unedoedo@yahoo.com. 2. Doctoral Program in Medical Sciences Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. unedoedo@yahoo.com. 3. Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. unedoedo@yahoo.com. 4. Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 5. Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, Hasan Sadikin Hospital, Universitas Padjadjaran, Bandung, Indonesia. 6. Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 7. Eijkman Institute for Molecular Biology, Jakarta, Indonesia. 8. Department of Anatomic Pathology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 9. Occupational Medicine Division, Community Medicine Department, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. 10. Department of Anatomic Pathology, Budhi Asih Hospital, Jakarta, Indonesia. 11. Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, Tarakan Hospital, Jakarta, Indonesia. 12. Department of Obstetrics and Gynecology, Karawang General Public Hospital, Karawang, Indonesia.
Abstract
BACKGROUND: The conventional standard treatment for ovarian cancer is not very effective, and the disease is fatal for women. Cancer Stem Cells (CSCs) that express CD44+/CD24- can contribute to chemoresistance and a poor prognosis. We seek to investigate the expression of CSCs (CD44+/CD24-) in ovarian cancer and their predictive significance. METHODS: The ambispective cohort was performed on 64 patients (32 patients in each group) at four hospitals (Cipto Mangunkusumo, Tarakan, Fatmawati, and Dharmais Hospital). Debulking surgery was performed on the patients, followed by histopathological analysis. The patients had six rounds of chemotherapy and were under monitoring for six months. The therapeutic responses were evaluated using the RECIST criteria (Response Criteria in Solid Tumors) and categorized as chemoresistant or chemosensitive. Using immunohistochemistry, we directly assess the CSCs from ovarian cancer tissue and using flow cytometry to assess the CSCs from the blood. RESULTS: High CSCs expression and ovarian cancer chemoresistance were significantly related in both trials (p 0.05). A better outcome was obtained using CD44+/CD24- immunohistochemistry. CONCLUSIONS: We conclude that there is a substantial association between high CSCs expression and chemoresistance in ovarian cancer and that CSCs immunohistochemistry has a higher predictive value.
BACKGROUND: The conventional standard treatment for ovarian cancer is not very effective, and the disease is fatal for women. Cancer Stem Cells (CSCs) that express CD44+/CD24- can contribute to chemoresistance and a poor prognosis. We seek to investigate the expression of CSCs (CD44+/CD24-) in ovarian cancer and their predictive significance. METHODS: The ambispective cohort was performed on 64 patients (32 patients in each group) at four hospitals (Cipto Mangunkusumo, Tarakan, Fatmawati, and Dharmais Hospital). Debulking surgery was performed on the patients, followed by histopathological analysis. The patients had six rounds of chemotherapy and were under monitoring for six months. The therapeutic responses were evaluated using the RECIST criteria (Response Criteria in Solid Tumors) and categorized as chemoresistant or chemosensitive. Using immunohistochemistry, we directly assess the CSCs from ovarian cancer tissue and using flow cytometry to assess the CSCs from the blood. RESULTS: High CSCs expression and ovarian cancer chemoresistance were significantly related in both trials (p 0.05). A better outcome was obtained using CD44+/CD24- immunohistochemistry. CONCLUSIONS: We conclude that there is a substantial association between high CSCs expression and chemoresistance in ovarian cancer and that CSCs immunohistochemistry has a higher predictive value.