Another study associated enhanced cytoplasmic ALCAM expression with reduced disease free survival rates, suggesting a role for strong cytoplasmic ALCAM expression as a marker of aggressive disease [15], whereas evaluation of membranous staining in a different study reported a link between decreased ALCAM expression and advanced tumor size, grade, negative estrogen and progesterone status and poorer survival rates, noting links between cytoplasmic staining and stronger membranous staining [12]. This evidence concerns the gene ALCAM and neoplasm.