The Role of CD44 Cancer Stem Cell Marker in the Development and Progression of Lymph Node Metastasis in Oral Squamous Cell Carcinoma

Introduction: Oral squamous cell carcinoma (OSCC) management is challenging due to high tendency of local invasion and metastasis. Cancer stem cells hold high significance as they have self-renewal ability, which further allows cancer progression and metastasis. Hence, it is crucial to evaluate different specialised markers for stem cells, such as CD44, to detect their role in tumour metastasis. Flow cytometry (FCM) offers a quick and automated assessment of ploidy status and cell proliferation of the neoplasm by resolving the nuclear DNA contents. Aim of the study: The objective of this paper is to evaluate the CD44 expression and analyse DNA content by FCM to predict the expansion of lymph node metastasis in patients with OSCC. Material and Methods: 50 paraffin-embedded tissues of metastatic and non-metastatic lymph node OSCC were immuno stained by CD44 for assessing cancer stem cell activity in each lesion. Furthermore, each selected tissue underwent flow cytometric analysis to demonstrate the DNA activity between the tested groups. Results: The CD44 expression in OSCCs showed a marked difference between the metastatic and non-metastatic lymph node cases. Furthermore, flow cytometric analysis of the DNA parameters between the tested groups revealed a powerful difference of DNA ploidy. The S-phase fraction (SPF) between the groups showed no compelling result. All specimens had a higher CD44 expression, aneuploid DNA content and high SPF, which demonstrated deposits of cervical metastatic lymph nodes. Conclusions: The CD44 and the flow cytometric analysis of the DNA ploidy correlation offer a significant prediction to determine the OSCC competence