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Cancer Stem Cell–Related Marker NANOG Expression in Ovarian Serous Tumors: A Clinicopathological Study of 159 Cases
  1. Nataša Kenda Šuster, MD,
  2. Snježana Frković Grazio, PhD, MD,
  3. Irma Virant-Klun, PhD,
  4. Ivan Verdenik, PhD and
  5. Špela Smrkolj, MD, PhD
  1. Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.
  1. Address correspondence and reprint requests to Špela Smrkolj, MD, PhD, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Šlajmerjeva 3, SI-1000 Ljubljana, Slovenia. E-mail: spsmrkolj{at}, spela.smrkolj{at}


Objective The objectives of this study were to assess cancer stem cell–related marker NANOG expression in ovarian serous tumors and to evaluate its prognostic significance in relation to ovarian serous carcinoma.

Methods NANOG protein expression was immunohistochemically evaluated in the ovarian tissue microarrays of 20 patients with benign ovarian serous tumors, 30 patients with borderline ovarian serous tumors, and 109 patients with ovarian serous carcinomas, from which 106 were of high-grade and 3 of low-grade morphology Immunohistochemical reaction was scored according to signal intensity and the percentage of positive cells in tumor samples. Pursuant to our summation of signal intensity and positive cell occurrence, we divided our samples into 4 groups: NANOG-negative, NANOG–slightly positive, NANOG–moderately positive, and NANOG–strongly positive group. Complete clinical data were obtained for the ovarian serous carcinoma group, and correlation between clinical data and NANOG expression was analyzed.

Results A specific brown nuclear, or cytoplasmic reaction, was considered a positive NANOG staining. In terms of the ovarian serous carcinoma group, 69.7% were NANOG positive, 22.9% slightly positive, 22.9% moderately positive, and 23.9% strongly positive. All NANOG-positive cases were of high-grade morphology. Benign and borderline tumors and low-grade serous carcinomas were NANOG negative. There was no significant correlation between NANOG expression and clinical parameters in terms of the ovarian serous carcinoma group.

Conclusions Positive NANOG expression is significantly associated with high-grade ovarian serous carcinoma and is absent in benign, borderline, and low-grade serous lesions. In our study, there was no correlation between NANOG expression and clinical parameters, including its use in the prognosis of ovarian serous carcinoma.

  • Ovarian cancer
  • Cancer stem cell
  • Cancer stem cell marker

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  • The authors declare no conflict of interest.