Osteosarcoma is a malignant bone tumor that originates from the bone growth plate or osteogenic tissue. CD34 is a widely distributed molecular marker in vascular endothelial cells, hematopoietic stem cells, and tumor tissues[9]. Many studies have shown that CD34 plays an important role in the occurrence and development of osteosarcoma. CD34-positive osteosarcoma cells have stronger proliferation ability and apoptosis inhibition ability, which can promote tumor cell proliferation and invasion. At the same time, CD34 also participates in the interaction between osteosarcoma cells and the tumor microenvironment, as well as tumor angiogenesis and other processes[10]. CD40 is a cell membrane protein that is widely expressed in immune cells, including B cells, dendritic cells, macrophages, T cells, and is involved in regulating immune responses. CD34 and CD40 are widely recognized markers of cancer stem cells, which are closely related to the occurrence and development of tumors. Cancer stem cells are a subpopulation of tumor cells with self-renewal and tissue reconstruction abilities, which play important roles in the occurrence, growth, metastasis, and drug resistance of tumors[11]. In osteosarcoma cells, CD40 and CD34 may regulate the proliferation and differentiation of cancer stem cells and participate in the invasion and metastasis of osteosarcoma cells, in addition to regulating immune response. Therefore, future research can develop more effective treatment methods by regulating the expression and function of CD40 and CD34 to inhibit the proliferation and invasion of cancer stem cells.
We found that a correlation between the high expression of CD34 and CD40 in osteosarcoma tissue and poor histological differentiation. This correlation may be attributed to their involvement in various biological behaviors of tumors such as growth, metastasis, and invasion. CD34 is a common endothelial cell marker that is widely expressed on the surface of other tissues and tumor cells. In osteosarcoma, high expression of CD34 is associated with angiogenesis, tumor swelling, infiltration, invasion, and metastasis which are typical manifestations of poor histological differentiation. CD40, on the other hand, is a sensitive co-stimulatory molecule that is broadly expressed on the surface of immune system cells and many tumor cells[12]. In osteosarcoma, high expression of CD40 is associated with immune evasion, infiltration, invasion, and metastasis which are also typical manifestations of poor histological differentiation. Thus, the high expression of CD34 and CD40 in osteosarcoma may be related to the malignancy and increased biological behavior of the tumor, leading to poor histological differentiation[13]. The high expression of CD34 and CD40 in osteosarcoma is associated with tumor invasion and metastasis, which may promote the distant metastasis of osteosarcoma patients. In osteosarcoma, high expression of CD34 is associated with angiogenesis, which may promote the formation of new blood vessels by tumor cells, providing them with nutrition and oxygen, and thus enhancing their growth and metastatic potential, promoting the occurrence of distant metastasis#[14]. The high expression of CD40 is associated with immune evasion, which may accelerate the growth and metastasis of osteosarcoma by suppressing the recognition and attack of the immune system towards osteosarcoma cells, leading to the occurrence of distant metastasis. Simultaneously, the high expression of CD34 and CD40 may enhance the malignancy and metastatic potential of osteosarcoma by promoting angiogenesis and suppressing the attack of the immune system, leading to the occurrence of distant metastasis in osteosarcoma patients.
The present study also found a significant positive correlation between the expression of CD34 and CD40 in osteosarcoma tissue. The specific mechanism of mutual promotion between CD34 and CD40 in osteosarcoma tissue has not been reported, but data shows that they may be involved in the following biological processes. Firstly, high level of CD34 promotes the invasion and infiltration of osteosarcoma cells into blood vessels#[15]. Up-regulation of CD34 can stimulate tumor cells to produce hypoxia-inducible factor 1 (HIF-1) and promote the migration of endothelial cells to the inflammatory site of the tumor, thus forming new blood vessels. Secondly, the expression of CD40 is influenced by various types of cells in the tumor microenvironment that secrete pro-inflammatory cytokines and factors[16]. These factors such as tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) can stimulate the expression and function of CD40, thereby enhancing the immune and inflammatory responses inside the tumor. Additionally, CD34 and CD40 may also interact with each other by regulating the expression of tissue factors. For example, studies have found that under co-culture conditions of CD40L + T cells and osteosarcoma cells, the expression of stem cell factor (SCF) and basic fibroblast growth factor (bFGF) was significantly up-regulated, and these factors can promote angiogenesis and osteosarcoma cell growth[17]. In summary, CD34 and CD40 may interact with each other through multiple mechanisms in osteosarcoma tissue, promoting tumor growth, invasion, and metastasis.
The Kaplan-Meier method was used to analyze the survival time of patients, and the results showed that the survival time of patients in the CD34-positive and CD40-positive groups was significantly shorter than that in the corresponding negative control groups. The poor prognosis of osteosarcoma patients with high expression of CD34 and CD40 may be related to the following factors[18, 19]: (1) Tumor invasion and metastasis: CD34 is an endothelial cell marker, and its high expression suggests that osteosarcoma cells have the ability to invade blood vessel endothelial cells. In addition, high expression of CD40 can promote tumor cell metastasis and invasion and reduce patient survival. (2) Changes in tumor microenvironment: The expression of CD40 is influenced by cytokines in the tumor microenvironment, which can change the interaction between tumor cells and the microenvironment, leading to accelerated tumor cell growth, invasion, and metastasis. (3) Suppressed immune response: CD40 plays a role in activating and enhancing immune responses in immune cells. However, in osteosarcoma cells, high expression of CD40 may suppress immune responses, leading to tumor cells being ignored by the immune system and making treatment more difficult. (4) Chemotherapy resistance: High expression of CD34 and CD40 may be related to chemotherapy resistance in osteosarcoma cells. Some studies have shown that the efficacy of chemotherapy is poor in osteosarcoma patients with high expression of CD34 and CD40. High expression of CD34 and CD40 may increase the invasive, metastatic, and chemotherapy-resistant capabilities of osteosarcoma cells, while reducing the immune response of patients, increasing the difficulty of treatment, and therefore may result in a poor prognosis for patients.
In conclusion, this study found that tumor stem cell markers CD34 and CD40 are highly expressed in osteosarcoma tissue and have significant negative impacts on patients' clinical pathological parameters and prognosis.