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Clinical significance of FAP-α on microvessel and lymphatic vessel density in lung squamous cell carcinoma
  1. Ling Chen1,
  2. Meihui Chen2,
  3. Zenglei Han1,
  4. Fengxing Jiang3,
  5. Chunyuan Xu1,
  6. Yue Qin2,
  7. Ning Ding2,
  8. Yang Liu1,
  9. Tenglong Zhang1,
  10. Zhijie An1,
  11. Chengye Guo1
  1. 1 Department of Oncology, Qingdao Municipal Hospital, Qingdao, China
  2. 2 Institute of Clinical Medicine, Qingdao University Medical College, Qingdao, China
  3. 3 Division of Hepatobiliary and Pancreatic Surgery, Qingdao Municipal Hospital, Qingdao, China
  1. Correspondence to Professor Zhijie An, Department of Oncology, Qingdao Municipal Hospital, Qingdao 266000, China; 18661628172{at} and Professor Chengye Guo, Department of Oncology, Qingdao Municipal Hospital, Qingdao 266012, China; chengye_guo{at}


Aims We aimed to determine whether cancer-associated fibroblasts (CAFs) are associated with microvessel density (MVD) and lymphatic vessel density (LVD) in lung squamous cell carcinoma, as well as their clinical significance in predicting survival.

Methods 122 patients were enrolled in the study. Samples were obtained on resection at the Department of Thoracic Surgery of the Qingdao Municipal Hospital between January 2011 and December 2014. Immunohistochemistry was used to determine vessel and lymphatic vessel density, and CAF abundance (fibroblast activation protein α (FAP-α) positivity). Statistical analyses were performed on 85 patients to test for correlation of CAF density and other clinicopathological variables with 3-year overall survival (OS) and disease-free survival (DFS).

Results High stromal CAF abundance significantly correlated with increased MVD and LVD in lung squamous cell carcinoma (p<0.05). χ2 test revealed a significant association of CAF density with lymph node metastasis. Cox proportional hazards model showed that both higher CAF density and lymph node metastasis negatively correlate with survival. CAF density or lymph node status can be used as an independent prognostic factor to predict 3-year OS and DFS.

Conclusions CAF density, identified by FAP-α staining pattern, should be considered as a novel biomarker for disease prognosis in patients with lung squamous cell carcinoma.

  • lung cancer
  • metastasis
  • tumour markers

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  • LC, MC and ZH are co-first authors.

  • Handling editor Dhirendra Govender.

  • Contributors All authors were involved in study design and data acquisition, as well as data analysis and drafting of the manuscript. All authors approved the final version of this study. LC, MC, ZH, FJ were involved in gathering samples, planning experiments and performing stainings as well as data analysis (statistics). Furthermore, they all participated in drafting this study. CX, YQ, ND, TZ were conducting immunohistochemical stainings, and analysed the results; they also participated in writing this manuscript. ZA and CG planned the study, analysed the data, drafted the manuscript and supervised the project.

  • Funding This study was funded by Qingdao Municipal Hospital.

  • Disclaimer The funder did not play any role in the conception, design and conduct of the study other than ensuring that the fund was correctly utilised for the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.