Abstract
Background and aims: Molecular pathogenesis of hepatocellular carcinoma (HCC) is not yet clear despite the global widespread of this disease. Currently the significant association between cancer stem cells and various solid tumors acquired a great attention. Therefore, the aim of this study was to investigate the expression of hepatic cancer stem cells (CD44) in HCC patients and to correlate the results with the disease outcome. Subjects and Methods: A total of 20 patients with HCV-associated HCC were included in this study. They were compared to 20 patients with HCV-related cirrhosis without HCC and  20 healthy controls. The hepatic expression of CD44 protein was assessed by immunohistochemistry (IHC). Results: Compared with cirrhotic patients without HCC and healthy controls, cirrhotic patients with HCC had significantly higher hepatic expression of CD44. The hepatic expression of CD 44 was correlated positively with blood levels of alpha-fetoprotein (AFP) (r = 0.29; p = 0.04). Significant associations were found between  the higher hepatic expression of CD44 and the increased frequency of patients with vascular invasion (93.7% vs 6.25%; p = 0.001). Conclusion: Increased hepatic expression of CD44 may have a role in growth and aggressiveness, of HCV-associated HCC, irrespective of the liver functional status.