Fibrosis in metastatic lymph nodes is clinically correlated to poor prognosis in colorectal cancer
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Daiji Ikuta1, Toru Miyake1, Tomoharu Shimizu1, Hiromichi Sonoda1, Ken-Ichi Mukaisho2, Aya Tokuda1, Tomoyuki Ueki1, Hiroyuki Sugihara2 and Masaji Tani1
1Department of Surgery, Shiga University of Medical Science, Shiga, Japan
2Department of Molecular and diagnostic Pathology, Shiga University of Medical Science, Shiga, Japan
Toru Miyake, email: firstname.lastname@example.org
Keywords: cancer-associated fibroblast; colorectal cancer; fibroblastic reticular cell; fibrosis; lymph node metastasis
Received: December 23, 2017 Accepted: June 03, 2018 Published: July 03, 2018
Background: Tumor microenvironment including fibrosis has a pivotal role in cancer growth and distant metastasis. Fibrosis is a known risk factor for carcinogenesis, but its biological role in disease invasion and metastasis in colorectal cancer (CRC) remains unclear. In particular, there is no report on how fibrosis of metastatic lymph nodes (MLNs) in CRC contributes to prognosis.
Methods: We reviewed 94 colorectal adenocarcinoma patients with MLNs who underwent colectomy. Both the primary tumors and MLNs were analyzed for alpha-smooth muscle actin (α-SMA) expression and collagen deposition.
Results: Higher α-SMA expression and collagen deposition in MLNs were associated with significantly shorter relapse-free survival and overall survival in CRC patients. α-SMA expression in MLNs (HR, 1.53; p = 0.034) was independent predictive factor of overall survival in multivariate Cox proportional hazards regression analysis of clinicopathological factors. In the Stage III patient subgroup, α-SMA expression in MLNs was a strong prognostic marker (HR, 3.01; p = 0.006). On the other hand, higher α-SMA expression and collagen deposition in primary tumors were associated with short overall survival, but they were not significant factors in multivariate Cox regression analyses. In MLNs, the podoplanin signals co-localized with α-SMA expression and were confirmed by the dual immunofluorescence staining, implying that the MLN stromal cells were fibroblastic reticular cells.
Conclusion: Both high collagen deposition and high α-SMA expression in MLNs predicted poor prognosis in CRC.
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