IMR Press / EJGO / Volume 42 / Issue 4 / DOI: 10.31083/j.ejgo4204118
Open Access Original Research
Association of cancer-associated fibroblasts and survival in malignant ovarian neoplasms
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1 Department of Gynecology and Obstetrics/Research Institute of Oncology (IPON), Federal University of Triângulo Mineiro, 38025-440 Uberaba-MG, Brazil
2 Surgical Pathology Service, Federal University of Triângulo Mineiro, 38025-440 Uberaba-MG, Brazil
Eur. J. Gynaecol. Oncol. 2021 , 42(4), 782–787; https://doi.org/10.31083/j.ejgo4204118
Submitted: 18 April 2021 | Revised: 1 June 2021 | Accepted: 21 June 2021 | Published: 15 August 2021
Abstract

Objective: The aims of the study were to compare the stromal immunostaining of smooth muscle alpha-actin (α-SMA) and fibroblast activation protein-α (FAP) between borderline ovarian tumors and epithelial ovarian cancer, and to evaluate their association in overall survival (OS) and disease-free survival (DFS) in patients with ovarian cancer. Methods: Patients diagnosed with malignant (n = 28) and borderline ovarian tumors (n = 18) were evaluated. Immunohistochemical study of stromal α-SMA and FAP was carried out. The comparison of immunostaining between borderline and malignant ovarian tumors was performed using Fisher’s exact test. Survival was assessed by the Kaplan-Meier method and the log-rank test. Multivariate analysis was performed by Cox regression. The differences were considered significant for p < 0.05. Results: Evaluating stromal FAP, stronger immunostaining (2 and 3) was more often found in epithelial ovarian cancer than in borderline ovarian tumors (p = 0.0331). There was no statistical significance in the assessment of α-SMA. Evaluating only patients with epithelial ovarian cancer, there was a higher OS in patients with stromal α-SMA immunostaining 3 (p = 0.017). There was no statistical significance when evaluating OS and DFS in patients with stromal FAP immunostaining, nor evaluating DFS in patients with α-SMA stromal immunostaining 3. After multivariate analysis, patients with stromal α-SMA immunostaining 3 had higher OS compared to immunostaining 0, 1 or 2 [OR (95% CI) = 0.107 (0.018–0.649), p = 0.015]. Conclusion: Stronger FAP immunostaining was more often found in epithelial ovarian cancer than in borderline ovarian tumors. In epithelial ovarian cancer, there was a higher OS in patients with stromal α-SMA immunostaining 3.

Keywords
Epithelial ovarian cancer
Borderline ovarian tumors
Smooth muscle alpha-actin
Fibroblast activation protein-α
Tumor microenvironment
Overall survival
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