@article{oai:shiga-med.repo.nii.ac.jp:00003291,
 author = {生田, 大二 and 三宅, 亨 and 清水, 智治 and 園田, 寛道 and 向所, 賢一 and 徳田, 彩 and 植木, 智之 and 杉原, 洋行 and 谷, 眞至 and IKUTA, Daiji and MIYAKE, Toru and SHIMIZU, Tomoharu and SONODA, Hiromichi and MUKAISHO, Ken-ichi and Tokuda, Aya and UEKI, Tomoyuki and SUGIHARA, Hiroyuki and TANI, Masaji},
 issue = {51},
 journal = {Oncotarget},
 month = {Jul},
 note = {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.},
 pages = {29574--29586},
 title = {Fibrosis in metastatic lymph nodes is clinically correlated to poor prognosis in colorectal cancer.},
 volume = {9},
 year = {2018}
}