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Strahlentherapie und Onkologie
Article . 2024 . Peer-reviewed
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Other literature type . 2024
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Correlation of microscopic tumor extension with tumor microenvironment in esophageal cancer patients

Authors: Igbo, B. T.; Jentsch, C.; Linge, A.; Plesca, I.; Kuzay, Y.; Löck, S.; Kumaravadivel, M.; +10 Authors

Correlation of microscopic tumor extension with tumor microenvironment in esophageal cancer patients

Abstract

Abstract Objective In the era of image-guided adaptive radiotherapy, definition of the clinical target volume (CTV) is a challenge in various solid tumors, including esophageal cancer (EC). Many tumor microenvironmental factors, e.g., tumor cell proliferation or cancer stem cells, are hypothesized to be involved in microscopic tumor extension (MTE). Therefore, this study assessed the expression of FAK, ILK, CD44, HIF-1α, and Ki67 in EC patients after neoadjuvant radiochemotherapy followed by tumor resection (NRCHT+R) and correlated these markers with the MTE. Methods Formalin-fixed paraffin-embedded tumor resection specimens of ten EC patients were analyzed using multiplex immunofluorescence staining. Since gold fiducial markers had been endoscopically implanted at the proximal and distal tumor borders prior to NRCHT+R, correlation of the markers with the MTE was feasible. Results In tumor resection specimens of EC patients, the overall percentages of FAK+, CD44+, HIF-1α+, and Ki67+ cells were higher in tumor nests than in the tumor stroma, with the outcome for Ki67+ cells reaching statistical significance (p < 0.001). Conversely, expression of ILK+ cells was higher in tumor stroma, albeit not statistically significantly. In three patients, MTE beyond the fiducial markers was found, reaching up to 31 mm. Conclusion Our findings indicate that the overall expression of FAK, HIF-1α, Ki67, and CD44 was higher in tumor nests, whereas that of ILK was higher in tumor stroma. Differences in the TME between patients with residual tumor cells in the original CTV compared to those without were not found. Thus, there is insufficient evidence that the TME influences the required CTV margin on an individual patient basis. Trial registration number and date BO-EK-148042017 and BO-EK-177042022 on 20.06.2022, DRKS00011886, https://drks.de/search/de/trial/DRKS00011886.

Keywords

Male, Esophageal Neoplasms, Proliferation, Immunohistochemical analysis, Multiparametric analysis, Middle Aged, Hypoxia-Inducible Factor 1, alpha Subunit, Neoadjuvant Therapy, Tumor stem cell, Hyaluronan Receptors, Ki-67 Antigen, Fiducial Markers, Focal Adhesion Kinase 1, Tumor Microenvironment, Biomarkers, Tumor, Humans, Original Article, Female, Hypoxia, Female [MeSH] ; Hypoxia ; Esophageal Neoplasms/therapy [MeSH] ; Aged [MeSH] ; Humans [MeSH] ; Hyaluronan Receptors/metabolism [MeSH] ; Multiparametric analysis ; Fiducial Markers [MeSH] ; Middle Aged [MeSH] ; Esophageal Neoplasms/pathology [MeSH] ; Tumor stem cells ; Ki-67 Antigen/analysis [MeSH] ; Neoadjuvant Therapy [MeSH] ; Original Article ; Clinical Target Volume ; Hyaluronan Receptors/analysis [MeSH] ; Male [MeSH] ; Radiotherapy, Image-Guided [MeSH] ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism [MeSH] ; Proliferation ; Immunohistochemical analysis ; Biomarkers, Tumor/analysis [MeSH] ; Focal Adhesion Kinase 1/metabolism [MeSH] ; Tumor Microenvironment [MeSH], Aged, Radiotherapy, Image-Guided

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
1
Average
Average
Average
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