Soluble CD44 splice variants and pelvic lymph node metastasis in ovarian cancer patients

Alternative splicing of CD44 and aberrant levels of soluble CD44 protein in the serum of cancer patients has been correlated to tumor progression and metastasis. To examine the clinical value of CD44 serum levels (sCD44) in o varian cancer we determined concentrations of the soluble, variable isoform s sCD44std, sCD44v5 and sCD44v6 with a sensitive ELISA. Pre-operative serum samples from 66 patients with histologically diagnosed invasive disease as well as sera taken from 40 healthy blood donors were analyzed. In sera of ovarian cancer patients we detected elevated concentrations of overall CD44 serum levels represented by sCD44std (p=0.001), but decreased levels of th e specific isoforms CD44v5 (p=0.0002) and v6 (p=0.0001). This is the first report demonstrating that ovarian cancer patients with pelvic lymph node me tastasis at the time of diagnosis showed specifically elevated sCD44v6 (p=0 .073) serum concentrations in comparison to patients without lymph node inv olvement, whereas overall sCD44 serum levels did not differ. Decreased seru m levels of sCD44v5 were found in progesterone receptor-positive tumors (p= 0.059) and postmenopausal patients (p=0.032). Increased concentrations of s CD44v6 were detectable in estrogen receptor-positive tumors but not signifi cantly (p=0.138). Serum CD44v5 levels were associated with shortened relaps e-free survival time. No association was found between serum CD44 isoforms and the classical clinicopathological parameters stage and grading or overa ll survival. CD44 splice variants are possibly involved in a complex intera ction with the hormonal environment during tumorigenesis and metastasis of ovarian cancer.