Effect Of Interstitial Fibroblast Activation Protein-α Expression On Lymph Node Metastasis Of Esophageal Squamous Cell Carcinoma

Background and Objectives: Esophageal squamous cell carcinoma(ESCC)remains one of the most common malignancies in China and has a high metastasis rate and poor prognosis.Fibroblast activation protein-α(FAP-α)is a serine peptidase the expression of which in cancer-associated fibroblasts has been associated with a higher risk of metastases and poor survival.This study aimed to analyze the correlation of FAP-αexpression with the lymph node metastasis and prognostic significance in ESCC.Methods: FAP-α expression was examined in 121 resected ESCC specimens and 10 adjacent normal tissue using immunohistochemistry.FAP-α expression was scored in the stromal fibroblasts adjacent to neoplastic nests.A chi-square test was used to analyze the correlation between FAP-α expression in tumors stromal and lymph node metastasis of ESCC.The association between FAP-α expression and prognosis was evaluated using univariable and multivariable statistical modeling.Results: FAP-α expression was absent in the benign controls.FAP-α expression was evident in the stromal 37%(45/121)of ESCC.Expression of FAP-α level is significantly associated with lymph node metastasis(p=0.023),but it is not correlated to age,gender,and tumor location in ESCC patients.Stromal FAP-α expression was significantly associated with poor survival in univariable(HR 2.009;95% CI1.259-3.205;p=0.003)and multivariable analysis(HR 1.833;95% CI 1.144-2.937;p=0.012).Conclusions: FAP-α may be an important regulator in lymph node metastasis of ESCC and may provide a novel therapeutic target in ESCC.