Stromal FAP is an independent poor prognosis marker in non-small cell lung adenocarcinoma and associated with p53 mutation. (May 2021)

• Record Type: Journal Article
• Authors: Moreno-Ruiz, Pablo; Corvigno, Sara; te Grootenhuis, Nienke C.; La Fleur, Linnéa; Backman, Max; Strell, Carina; Mezheyeuski, Artur; Hoelzlwimmer, Gabriele; Klein, Christian; Botling, Johan; Micke, Patrick; Östman, Arne
• Is Part Of: Lung cancer. Volume 155(2021)
• Page Start: 10
• Page End: 19
• Publication Date: 2021-05
• Subjects: FAP -- Fibroblast -- Stroma -- PDGFβR -- α-SMA -- Biomarkers -- CD8 -- Non–small-cell lung cancer; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2021.02.028
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: High FAP stroma intensity is a poor prognosis marker in non-small cell lung cancer. P53 mutation is positively associated with fibroblast stroma features. Fibroblast markers show subset-specific associations with CD8 cells. Abstract: Objectives: Fibroblasts regulate tumor growth and immune surveillance. Here, we study FAP, PDGFβR and α-SMA fibroblast markers in a well-annotated clinical cohort of non–small-cell lung cancer (NSCLC) for analyses of associations with immune cell infiltration, mutation status and survival. Materials and Methods: A well-annotated NSCLC cohort was subjected to IHC analyses of stromal expression of FAP, PDGFβR and α-SMA and of stromal CD8 density. Fibroblast markers-related measurements were analyzed with regard to potential associations with CD8 density, cancer genetic driver mutations, survival and PD-L1 expression in the whole NSCLC cohort and in subsets of patients. Results: High stromal FAP expression was identified as an independent poor prognostic marker in the whole study population (HR 1.481; 95 % CI, 1.012–2.167, p = 0.023) and in the histological subset of adenocarcinoma (HR 1.720; 95 % CI, 1.126–2.627, p = 0.012). Among patients with adenocarcinoma, a particularly strong association of FAP with poor survival was detected in patients with low stromal CD8 infiltration, and in other subpopulations identified by specific clinical characteristics; elderly patients, females, non-smokers and patients with normal ECOG performance status. α-SMA expression was negatively associated with CD8 infiltration in non-smokers, but none of the fibroblast markers expression was associated with CD8 density in the whole study population. Significant associations were detected between presence of p53 mutations and high α-SMA (p = 0.003) and FAP expression (p < 0.001). Conclusion: The study identifies FAP intensity as a candidate independent NSCLC prognostic biomarker. The study also suggests continued analyses of the relationships between genetic driver mutations and the composition of tumor stroma, as well as continued probing of marker-defined fibroblasts as NSCLC subset-specific modifiers of immune surveillance and outcome.