الفهرس 
Epidmiology of colorectal cancerOnly 14 pages are availabe for public view
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Abstract
Colorectal carcinoma (CRC) is the third most prevalent type of cancer in the world. The overall mortality from CRC is 60%, which represents the second leading cause of cancer death in western societies. Cancer stem cells (CSCs) have role in cancer initiation, progression, and metastasis of CRC through their ability of self-renewal, unlimited proliferation and they seem to be responsible for local relapse and metastasis by inducing resistance against traditional drug therapy and there are several markers for CSCs have been investigated and proposed in colorectal cancer.Therefore, this study aimed to study immunohistochemical expression of ALDH1 and CD44 as stem cell markers in the carcinogenesis of CRC in Egyptian patients.This retrospective study included 71 colorectal specimen (49 colorectal carcinoma, 13 adenoma and 9 normal cases).The studied colorectal adenoma cases revealed that 76.9% of cases were ˃ 45 years old, also 69.2% of cases were males and 53.8% of cases showed low grade dysplasia.The studied CRC cases revealed that 71.4 % of the studied CRC were ˃ 45 years old, 62.2% of cases were females. 51% of cases were in right side, 53% showed fungating gross picture, 81.6% CRC cases were of adenocarcinoma type. Also 79.6% of cases were of grade II, 51% were of stage T stage B2, 14.3% of cases showed vascular invasion and 42.9% of cases showed lymph node invasion.The current study showed that there was statistical significant association between positivity of ALDH1and younger age, right sided tumor and presence of lymph node invasion (p ˂ 0.003, 0.038 and 0.04 respectively)The present study showed that there was statistical significant association between high expression of ALDH1, ulcerating gross picture and presence of vascular invasion (p= 0.01 and 0.05 respectively). Also there was statistical significant association between positive stromal expression of ALDH1 and smaller tumor size (p =0.03).Furthermore there was highly significant association between negative stromal expression of ALDH1 and higher tumor grade (p˂0.000).Also there was significant association between stromal expression of ALDH1 and perineural invasion (p = 0.05).The present study showed that there was a highly statistical significant difference between studied colorectal carcinoma cases , adenoma and normal regarding ALDH1 expression ( p˂0.000).The current study revealed no statistical significance between ALDH1 expression and sex , grade , necrosis , mitosis nor apoptosis.The current study showed that there was statistical significant association between positive expression of CD44 and left sided tumor (p = 0.013).The present study showed that there was statistical significance association between H. score of CD44 and older age group (p= 0.04) .
The current study showed that there was statistical significant association between stromal expression of CD44 and absence of lymph node invasion, advanced modified Dukes’ stage (p =0.002 and 0.02 respectively).
The present study showed that there was a highly statistical significance difference between studied colorectal carcinoma cases , adenoma cases and normal mucosa regarding CD44 expression (p=0.001).
The current study revealed no statistical significant between CD44 expression and sex, size, grade, stage, vascular invasion, perineural invasion, necrosis , mitosis nor apoptosis.
The current study showed that there was inverse significant difference between CD44 expression and ALDH1 expression as all studied colorectal carcinoma cases that were negative for CD44 were positive for ALDH1 (P=0.001).
The present study revealed no statistical significance between overall survival and clinicopathological data nor immunohistochemical expression of CD44 or ALDH1. While there was statistical significance between disease-free survival and sex and grade (p=0.02 and 0.03 respectively).