Research Papers:

Twist1 is highly expressed in cancer-associated fibroblasts of esophageal squamous cell carcinoma with a prognostic significance

So-Young Yeo, Sang-Yun Ha, Keun-Woo Lee, Yan Cui, Zhao-Ting Yang, Yan-Hua Xuan _ and Seok-Hyung Kim

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Oncotarget. 2017; 8:65265-65280. https://doi.org/10.18632/oncotarget.17941

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So-Young Yeo1,5,*, Sang-Yun Ha1,*, Keun-Woo Lee1,5,*, Yan Cui2, Zhao-Ting Yang3,4, Yan-Hua Xuan3,4 and Seok-Hyung Kim1,5

1Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

2Department of Oncology, Affiliated Hospital of Yanbian University, Yanji, China

3Key Laboratory of Natural Resources of the Changbai Mountain and Functional Molecules, Ministry of Education, Yanbian University, Yanji, China

4Department of Pathology, Yanbian University College of Medicine, Yanji, China

5Department of Health Science and Technology, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea

*These authors contributed equally to this work and are co-first authors

Correspondence to:

Yan-Hua Xuan, email: [email protected]

Seok-Hyung Kim, email: [email protected]

Keywords: Twist1, cancer associated fibroblast, stroma, esophageal squamous cell carcinoma

Received: August 15, 2016     Accepted: May 04, 2017     Published: May 17, 2017


Cancer-associated fibroblasts (CAFs) play important roles in cancer progression. Twist1 was recently reported to be a key regulator of CAFs in gastric cancer, but its role in other types of cancer remains unclear, especially for esophageal squamous cell carcinoma (ESCC). We assessed the Twist1 expression on stromal fibroblasts using immunohistochemistry in 169 tissue specimens from ESCC patients, and performed in vitro and in vivo experiments to confirm the role of Twist1 in CAFs of ESCC. And we investigated the biological pathways that are activated in Twist1-high ESCC using The Cancer Genome Atlas (TCGA) data. The expression of Twist1 in stromal fibroblasts was observed in 89.9% of ESCC patients and positively associated with the increased depth of tumor invasion, lymph node metastasis, and advanced clinical stage, and a significant adverse prognostic factor in overall survival. Twist1-expressing stromal fibroblasts also expressed representative CAF markers, and co-localization of Twist1 and CAF markers were confirmed by confocal immunofluorescence imaging. Bioinformatic analysis of mRNA expression data of esophageal cancer from TCGA revealed that gene sets of CAFs were highly enriched in Twist1-high ESCC. Depletion of Twist1 in ex vivo cultured ESCC CAFs induced significant decrease in migration, invasion, colony formation, sphere formation, and contractibility of ESCC cancer cells compared to control CAFs. Furthermore, Twist1-expressing fibroblasts remarkably enhanced the in vivo tumorigenicity of ESCC in a xenograft model. In conclusion, Twist1 could be a novel CAF marker for the prognostic evaluation of ESCC patients as well as a potent therapeutic target for ESCC.

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