Background: CD44, a cell hyaluronic acid transmembrane glycoprotein implicated in cell growth, differentiation, survival as well as the metastatic behavior of some cancer cells. Its expression is upregulated in subpopulations of cancer cells and is identified as a molecular marker for cancer stem cells (CSC). Methodology: This retrospective study investigated CD44 immunoreactivity in 85 cancer colon patient’s specimens at diagnosis obtained from the pathology department, South Egypt Cancer Institute. All specimens were stained by Anti CD44 antibody. Patients were followed up for 3 years. Aim: The study aims at inspecting CD44 immunoreactivity in the epithelium of colorectal cancer specimens and at detecting its association with the patients’ survival function by calculating disease free survival and overall survival of patients.

Results: In our current study there was a statistically significant association between low epithelial expression of CD44 marker (H score≤ 150) and 3-year OS (p= 0.009) as well as a statistically significant association between low CD44 epithelial expression and 2-year DFS (P= 0.041). In multivariate analysis the high epithelial expression of CD44 is the only independent factor for early recurrence (HR: 9.393, P= 0.031) concluding that high epithelial expression of CD44 is a bad prognostic factor and the likelihood of death is 9 times more with CD44 overexpression.

Conclusion: CD44 positivity in non-metastatic colorectal cancer specimens at diagnosis is associated with worse overall survival of patients and more likelihood of progression or death.