Clinicopathological association of CD44 and PD-L1 expression in epithelial ovarian carcinoma: a hospital-based cross-sectional study from AIIMS Patna

Manish Kumar Saroj; Punam Prasad Bhadani; Tarun Kumar; Jitendra Singh  Nigam; Monika Anant

doi:10.18203/2320-6012.ijrms20254087

Authors

Manish Kumar Saroj Department of Pathology, All India All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
Punam Prasad Bhadani Department of Pathology, All India All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
Tarun Kumar Department of Pathology, All India All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
Jitendra Singh Nigam Department of Pathology, All India All India Institute of Medical Sciences (AIIMS), Bibinagar, Telangana, India
Monika Anant Department of Obstetrics and Gynaecology, All India All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20254087

Keywords:

Epithelial ovarian carcinoma, CD44, PD-L1, Immunohistochemistry, Prognostic markers

Abstract

Background: Epithelial ovarian carcinoma (EOC) is the most lethal gynecological malignancy, often presenting at advanced stages. Molecular markers such as CD44, a stem cell-associated adhesion molecule, and PD-L1, an immune checkpoint regulator, have been implicated in tumor progression, chemoresistance, and immune evasion. Understanding their expression patterns and correlation with clinicopathological features may aid prognostic stratification and therapeutic decision-making. Aim was to assess CD44 and PD-L1 expression in EOC and analyze their association with clinicopathological parameters.

Methods: A hospital-based cross-sectional study was conducted over 5 years (2018-2023) in the department of pathology, AIIMS Patna. A total of 132 histologically confirmed cases of EOC were included. Immunohistochemistry (IHC) for CD44 and PD-L1 was performed, and expression was scored semi-quantitatively. Associations with age, histological subtype, tumor grade, stage, and lymph node involvement were evaluated. Statistical analysis was performed using chi-square and logistic regression.

Results: CD44 positivity was observed in 79/132 cases (59.8%), while PD-L1 was expressed in 62/132 cases (47.0%). Co-expression of both markers was found in 38 cases (28.8%). High CD44 expression was significantly associated with high-grade serous carcinoma (p=0.01), advanced FIGO stage (p=0.03), and lymph node metastasis (p=0.04). PD-L1 positivity correlated with advanced stage (p=0.02) and presence of ascites (p=0.03). Co-expression was linked to poor differentiation and advanced disease. Multivariate analysis showed CD44+/PD-L1+ tumors had 2.6-fold higher odds of lymph node metastasis.

Conclusions: CD44 and PD-L1 are frequently expressed in EOC and show significant association with adverse pathological features. Their combined expression may serve as a prognostic biomarker and highlight potential candidates for targeted and immune checkpoint therapies in ovarian carcinoma.

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