Abstract 349: Fascin expression in colorectal cancer metastases predicts survival after curative-intent surgery

Abstract

Abstract Background: Patients with metastatic colorectal cancer that is limited to a few lesions in the lungs or liver may benefit from the complete surgical removal of all deposits of metastatic cancer (referred to as a curative metastasectomy). Although the outcome after this curative-intent surgery is considerably better than patients with more extensive metastatic cancer, only a third of the surgical patients are actually cured. As a result, there is a great need for a mechanism to predict outcome after surgery for limited metastatic cancer, in order to better match patients with effective therapy. Fascin is an actin bundling protein linked to epithelial to mesenchymal transformation and metastatic progression. Fascin expression has previously demonstrated prognostic potential in patients with extensive metastatic colorectal cancer. We hypothesized that Fascin expression within surgically removed colorectal cancer metastases would correlate with survival after curative-intent surgery. Methods: 82 paraffin embedded colorectal metastases collected after curative-intent surgery between 1990 and 2008 were incorporated into tissue microarrays (TMAs) in two fold redundancy. Fascin expression within the metastases was determined by quantitative immunofluorescence using Automated Quantitative Analysis (AQUA), and normalized based on a panel of cell lines (AQUA score range 0-72). The median follow up was 2.8 years and thus far 51 patients have died (62%). Results: The majority of colorectal cancer metastases had been removed from the liver (70 patients), while 12 represented pulmonary metastases. There were no differences in survival by location of metastases (p = .65). Survival was analyzed based on high (top quartile, n = 21) and low (bottom three quartiles, n = 61) expression of Fascin (AQUA score cut point of 3.4). High expression of Fascin correlated with a worse prognosis, HR 1.97; 95% CI 1.07-3.62 p = .009. Conclusions: Fascin expression within colorectal cancer metastases may be used to predict outcome after curative-intent surgery. Patients with high Fascin expression may be considered for additional therapy or may be advised against particularly high risk procedures. Further study is warranted to validate the role of Fascin expression analysis in this patient cohort. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 349. doi:10.1158/1538-7445.AM2011-349