Middle East Journal of Cancer

Combined Cancer Stem Cell Signatures Improve Recurrence Stratification Compared with Single Biomarkers in Advanced Epithelial Ovarian Cancer

Articles in Press

Document Type : Original Article(s)

Authors

I Nyoman Gede Budiana
Kade Yudi Saspriyana

Department of Obstetrics and Gynecology, Gynecology Oncology Division, Prof. Dr. I.G.N.G Ngoerah General Hospital/ Faculty of Medicine, Udayana University, Bali, Indonesia

10.30476/mejc.2026.111805.2434
Abstract
Background: The prognostic value of individual cancer stem cell (CSC) markers in epithelial ovarian cancer (EOC) remains inconsistent. The present study compared combined CSC signatures with individual markers for prognostic stratification in advanced EOC.
Method: This retrospective–prospective cohort study included 114 patients with stage II–IV EOC at a tertiary referral hospital in Indonesia. Progression-free survival (PFS) and recurrence were assessed over 24 months. Immunohistochemical expression of cluster of differentiation 24 (CD24), CD44, CD133, CD117, and aldehyde dehydrogenase (ALDH) was evaluated using semiquantitative histochemical scoring. Receiver operating characteristic (ROC) analysis, Kaplan–Meier analysis with log-rank testing, and Cox proportional hazards regression were performed using Statistical Package for the Social Sciences (SPSS) version 25, with P < 0.05 considered statistically significant.
Results: Individual markers showed poor discrimination for recurrence, with areas under the curve (AUCs) ranging from 0.469 to 0.578. The five-marker signature also showed poor ROC discrimination (AUC = 0.518; P = 0.748), but stratified 2-year PFS differed between the low- and high-expression groups (76.9 vs. 29.7%; P = 0.009). The five-marker signature was associated with recurrence (hazard ratio (HR) = 8.985; 95% confidence interval (CI) = 1.879–42.978; P = 0.006), whereas the CD117–ALDH combination was associated with a lower recurrence hazard (HR = 0.394; 95% CI = 0.198–0.784; P = 0.008).
Conclusion: Individual CSC markers had limited prognostic discrimination. The five-marker signature was associated with PFS and recurrence, but its discriminatory accuracy remained poor. These exploratory findings require validation in larger prospective cohorts.

Highlights

I Nyoman Gede Budiana (google scholar)

 

Keywords

Biomarker, Neoplastic stem cells, Ovarian neoplasms
Progression-free survival, Tumor recurrence
Subjects

Please cite this article as:

Budiana ING, Saspriyana KY. Combined Cancer Stem Cell Signatures Improve Recurrence Stratification Compared with Single Biomarkers in Advanced Epithelial Ovarian Cancer. Middle East J Cancer. 2026: in press. doi: 10.30476/mejc.2026.111805.2434.

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Middle East Journal of Cancer

Articles in Press, Accepted Manuscript
Available Online from 01 July 2027

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