CD44+/CD24− ovarian cancer cells demonstrate cancer stem cell properties and correlate to survival

Cancer cells with the surface marker profile CD44+/CD24− have previously been described to possess cancer stem cell-like properties. This manuscript evaluates those properties in ovarian cancer cell lines. The proportion of CD44+/CD24− cells corresponded to the clinical aggressiveness of each ovarian cancer cell line histologic subtype. CD44+/CD24− cells demonstrated enhanced progressive differentiation as well as showing a 60-fold increase in Matrigel invasion in both SKOV3 and OV90 cell lines (p < 0.001 each) compared to other phenotypes. CD44+/CD24− demonstrated significant resistance to all chemotherapy agents used in all cell lines, with a 71–93 % increase in resistance compared with baseline. Using a threshold of 25 % CD44+/CD24– ovarian cancer cells found in ascites, patients with >25 % CD44+/CD24− were significantly more likely to recur (83 vs. 14 %, p = 0.003) and had shorter median progression-free survival (6 vs. 18 months, p = 0.01). In conclusion, the CD44+/CD24− phenotype in ovarian cancer cells demonstrate cancer stem cell-like properties of enhanced differentiation, invasion, and resistance to chemotherapy. This CD44+/CD24− phenotype correlates to clinical endpoints with increased risk of recurrence and shorter progression-free survival in patients with ovarian cancer.