Cancer-associated fibroblasts in epithelial ovarian carcinoma: relation to clinicopathologic characteristics and microvessel density

Abstract

Background Epithelial ovarian carcinoma (EOC) is the leading cause of mortality among all gynecologic cancers. Recent studies have emphasized the role of the tumor microenvironment in tumor progression. Cancer-associated fibroblasts (CAFs) are the most frequent component in the tumor microenvironment, and α-smooth muscle actin (α-SMA) is the most commonly used marker to identify CAF. This study aimed to investigate the potential role of CAFs in the progression of EOC. Furthermore, we analyzed the relation between the presence of CAF in EOC and clinicopathologic characteristics and tumor microvessel density (MVD). Methods Immunohistochemical staining was performed on 75 cases of epithelial ovarian neoplasms using α-SMA (as a marker of CAFs) and CD34 (for assessment of MVD in EOC cases). Results The presence of CAFs, as assessed by α-SMA intensity and percentage of positive stained area, was significantly more prominent in malignant cases, as compared with borderline and benign cases. It was found that abundant CAFs were significantly associated with high-grade tumors, stage III tumors and tumors with vascular invasion and omental metastasis. A significant positive correlation was detected between the presence of CAFs and tumor MVD in EOC. Conclusion CAFs significantly increase from benign through borderline to malignant ovarian neoplasms. CAFs are significantly higher in high-grade tumors, advanced stage tumors and in tumors with vascular invasion or omental metastasis. CAFs are significantly correlated with tumor MVD in EOC. Thus, CAFs may serve as a poor prognostic indicator in patients with EOC.