Correlation of CD133, OCT4, and SOX2 in rectal cancer and their association with distant recurrence after chemoradiotherapy

Ann Surg Oncol. 2009 Dec;16(12):3488-98. doi: 10.1245/s10434-009-0617-z.


Background: Cancer stem cells are associated with metastatic potential, treatment resistance, and poor patient prognosis. Distant recurrence remains the major cause of mortality in rectal cancer patients with preoperative chemoradiotherapy (CRT). We investigated the role of three stem cell markers (CD133, OCT4, and SOX2) in rectal cancer and evaluated the association between these gene levels and clinical outcome in rectal cancer patients with preoperative CRT.

Methods: Thirty-three patients with rectal cancer underwent preoperative CRT. Total RNAs of rectal cancer cells before and after CRT were isolated. Residual cancer cells after CRT were obtained from formalin-fixed paraffin-embedded (FFPE) specimens using microdissection. The expression levels of three stem cell genes were measured using real-time reverse-transcription polymerase chain reaction (RT-PCR). The association between these gene levels and radiation was evaluated using colon cancer cell lines. Immunohistochemical staining of these markers after CRT was also investigated.

Results: There were significant positive correlations among the three genes after CRT. Patients who developed distant recurrence had higher levels of the three genes compared with those without recurrence in residual cancer after CRT. These elevated gene levels were significantly associated with poor disease-free survival. The radiation caused upregulation of these gene levels in LoVo and SW480 in vitro. Immunohistochemically, CD133 staining was observed in not only luminal surface but also cytoplasm.

Conclusions: Expression of CD133, OCT4, and SOX2 may predict distant recurrence and poor prognosis of rectal cancer patients treated with preoperative CRT. Correlations among these genes may be associated with tumor regrowth and metastatic relapse after CRT.

MeSH terms

  • AC133 Antigen
  • Adult
  • Aged
  • Antigens, CD / genetics
  • Antigens, CD / metabolism*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biomarkers, Tumor / metabolism
  • Colonic Neoplasms / drug therapy
  • Colonic Neoplasms / metabolism*
  • Colonic Neoplasms / radiotherapy
  • Combined Modality Therapy
  • Female
  • Fluorouracil / administration & dosage
  • Glycoproteins / genetics
  • Glycoproteins / metabolism*
  • Humans
  • Immunoenzyme Techniques
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / metabolism*
  • Neoplasm Recurrence, Local / radiotherapy
  • Neoplasm Staging
  • Neoplasm, Residual / drug therapy
  • Neoplasm, Residual / metabolism
  • Neoplasm, Residual / radiotherapy
  • Octamer Transcription Factor-3 / genetics
  • Octamer Transcription Factor-3 / metabolism*
  • Peptides / genetics
  • Peptides / metabolism*
  • Prognosis
  • RNA, Messenger / genetics
  • RNA, Messenger / metabolism
  • Radiotherapy Dosage
  • Rectal Neoplasms / drug therapy
  • Rectal Neoplasms / metabolism*
  • Rectal Neoplasms / radiotherapy
  • Retrospective Studies
  • Reverse Transcriptase Polymerase Chain Reaction
  • SOXB1 Transcription Factors / genetics
  • SOXB1 Transcription Factors / metabolism*
  • Survival Rate
  • Tegafur / administration & dosage
  • Tumor Cells, Cultured
  • Uracil / administration & dosage


  • AC133 Antigen
  • Antigens, CD
  • Biomarkers, Tumor
  • Glycoproteins
  • Octamer Transcription Factor-3
  • POU5F1 protein, human
  • PROM1 protein, human
  • Peptides
  • RNA, Messenger
  • SOX2 protein, human
  • SOXB1 Transcription Factors
  • Tegafur
  • Uracil
  • Fluorouracil