Prognostic Value of CD10 among Tunisian Patients with Nasopharyngeal Carcinoma

Research Article

Ann Hematol Oncol. 2021; 8(11): 1373.

Prognostic Value of CD10 among Tunisian Patients with Nasopharyngeal Carcinoma

Mokni Baizig N¹*, Mhamdi H¹, El Amine El Hadj O¹, Goucha A¹, Hsairi M² and Touati S³

1Laboratory of Immuno-Histo-Cytology, Institute of Carcinology, Salah Azaiz, Tunis, Tunisia

2Department of Statistics and Medical Informatics, Institute of Carcinology, Salah Azaiz, Tunis, Tunisia

3Department of ORL, Institute of Carcinology, Salah Azaiz, Tunis, Tunisia

*Corresponding author: Mokni Baizig N, Laboratory of Immmuno-Histo-Cytology, Salah Azaiz Cancer Institute, 1006 Bab Saadoun, Tunis, Tunisia

Received: August 13, 2021; Accepted: September 09, 2021; Published: September 16, 2021


Introduction: CD10 expression was identified as a marker of poor prognosis in several types of cancer. However, its impact on the survival of Tunisian NPC patients has not been discussed. So, our objective was to confirm the prognostic value of this marker, in addition to its relationship to clinicopathologic parameters.

Materials and Methods: Imunohistochemistry method was performed on formalin-fixed paraffin-embedded sections of 66 cases of NPC, 6 patients with inflammatory nasopharynx and 20 normal mucosa tissues.

Results: CD10 expression was detected in 66.66 % of the NPC with predominant staining in stromal cells (81.81%). While, no expression of CD10 was noted in control group (inflammatory nasopharyngeal lesions and normal nasopharynx mucosa).

CD10 positive cases were correlated with increasing tumor size (p=0.001) and lymph node metastasis (p=0.034). Furthermore, with the Kaplan-Meier test, a strong association was observed between the expression of CD10 and the recurrence status (p = 0.003). Multivariate Cox proportional hazard regression analysis showed that CD10 and lymph node metastasis factors were independent predictors of time to recurrence among NPC patients with respectively p=0.001 and p=0.044.

Conclusion: The present study confirms the prognostic value of CD10 expression and suggests its strong effect on aggressive behavior of nasopharyngeal carcinoma.

Keywords: CD10; Immunohistochemistry; Nasopharyngeal carcinoma (NPC); Survival


Nasopharyngeal Carcinoma (NPC) is a rare pathology, which is endemic in southeastern China and southeastern Asia with an annual incidence rate of approximately 20 per 100,000 people [1]. Although NPC is not as frequent in North Africa as it is in Asia, it remains the most frequent head and neck cancer in Tunisia, Algeria, and Morocco [2]. Despite significant radiosensitivity and chemosensitivity compared to other head and neck cancers, metastatic development of nasopharyngeal cancers (upper cervical lymphadenopathy) is common. Due to the anatomical situation of the nasopharyngeal cancer, tumor development can be asymptomatic for a long time. This often makes the diagnosis late and the prognosis relatively unfavorable.

EBV is one of the etiologic factors of NPC, particularly the undifferentiated form (UCNT) [3,4]. As previously described, EBV DNA has been detected in plasma, serum [5-7] or unfractionated whole blood [8-10] of NPC patients and suggested to be a sensitive and specific molecular marker for both diagnosis and prognosis. Until now, EBV remains the only biomarker used for clinical NPC patients follow-up. So the identification of new markers could be helpful for better diagnosis and prognosis. CD10 is the marker chosen for this study. In fact, it is a 90-110 kDa cell surface zinc-dependent metalloprotease, which possesses a well-defined enzymatic activity. It has also been called neutral endopeptidase and Common Acute Lymphoblastic Leukemia Antigen (CALLA) [10]. Expression of CD10 was observed on some normal and neoplastic hematopoietic, lymphoid and stromal epithelial cells [11,12]. It was detected in stroma of various malignancies including gastric, lung, breast, prostate and colorectal carcinomas [12-15]. On nasopharyngeal carcinoma, the only one study concerning CD10 expression published by Braham et al. [16] demonstrated the correlation of CD10 with tumor progression. We assumed that this result is not conclusive on the prognostic value of this marker. So, we proposed in the present study, to evaluate the association of CD10 expression and the survival of the NPC patients and to confirm the clinical impact of this marker.

Materials and Methods

Clinical and pathological data

This study was performed at Immuno Histo Cytology department in the Salah Azaiez Cancer Institute. The biopsy specimens were taken from 66 patients with Nasopharyngeal Carcinoma (NPC), diagnosed between 2008 and 2011. They were represented by 49 males and 17 females with age ranging from 13 to 79 years. As control group, we also included 6 cases with inflammatory nasopharyngeal lesions, and 20 samples from patients with normal nasopharynx mucosa.

Immunohistochemical Staining for CD10

We used 5μm slices for the immunohistochemical staining. The sections were deparaffinized in xylene, dehydrated in alcohol and washed in Phosphate Buffered Saline (PBS) and antigenic retrieval was done by incubation with 1% citrate buffer (pH=6) in a microwave oven for 40min . The endogenous peroxidase activity was blocked using 3% H2O2 for 5 minutes. Thereafter, the sections were incubated with primary anti-CD10 monoclonal antibody (56C6, Novo Castra, Newcastle, United Kingdom) as primary antibody for 60 minutes followed by incubation with post primary block for 30 minutes. Then, the sections were incubated with Novo Link polymer anti mouse/rabbit IgG-Poly-HRP for 30 minutes. Between each step, the sections were washed twice in Tris Buffer Saline (TBS). Sections were further incubated with the substrate, 3,3’-diaminobenzidine (DAB) chromogen prepared according to the manufacturer’s recommendations. Reactions with peroxidase produced a visible brown precipitate at the antigen site. Sections were counterstained with hematoxylin, rinsed in running tap water, dehydrated in ethanol (70%, 90%, and 100%, consecutively) and cleared with xylene.

Evaluation of immunostaining

The degree of staining was determined by two independent observers. CD10 was expressed on the apical membrane or in the cytoplasm. CD10 expression was highlighted in stromal lymphocytes. Staining was scored semi-quantitatively as negative (0), (no staining), and positive if more than 10% of the cells exhibited CD10 immunostaining. Positive immunostaining was categorized as weak (if less than 30% of the cells were positive), and as strong (when staining was more than 30% of the studied cells).

Statistical analysis

Data analyses were performed using the SPSS Statistics 20 software package.

Associations between the biomarker (CD10) and clinico pathological features of NPC patients and the survival or recurrence status, were analyzed using the Chi-square or Fisher’s exact test.

Association between the time to recurrence and stromal CD10 expression was performed using the Kaplan-Meier test. The log-rank test was used to evaluate statistical significance of the differences between the curves.

Cox proportional hazards regression model was used for multivariate analysis.

P-values <0.05 were considered as being statistically significant.


Expression of CD10 was determined by immunohistochemistry and results were shown in the Table 1.